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?`.,=�• ,, SAN JOAQUIN C& NTY <br /> ENVIORMENTAL HEALTH DEPARTMENT <br /> h <br /> 1868 East Il &Mton Avenue, Stockton,Catifornin 95205 <br /> Business: (209)468-3420 <br /> 1 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this <br /> checklist to the festival coordinator three(3) weeks prior to this event. <br /> 1. Name of Event:������f�— ir-r��:��--- w Date(s): . <br /> 2. The following is information about my organization/business: {� <br /> Name of or zation/business: -�r <br /> Address: /,Y t X 161 <br /> Phone: a o g 7 z? - .a s � - _ Alternate: $'3-- �-4 76 <br /> 3. List food to be sold or given to the public: c <br /> 4. 1 am providing food that is NOT prepared at home: Yes [ ] No <br /> All food is prepared on-site or is from approved commercial facilities: [ Yes [ ] No <br /> Name of facility: � • - 7 s Phone: e_� 7.2 7- - <br /> Address of facility: J E-Ze, ^z <br /> I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br /> flies, dust and the public) <br /> NA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br /> meth fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br /> (concrete, asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food <br /> preparation areas from the public. <br /> [ ] Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following <br /> methods: <br /> Approved bottled water. <br /> [ On-site hose bib that is connected to a potable water source. <br /> [ ) Other(specify): <br /> 7. Electricity is provided for my booth's use: Yes [ ] No <br /> 8. 1 am providing an accurate probe thermometer to easure the hot and cold holding of potentially hazardous <br /> foods during all time of booth operation. [ es [ ] No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br /> above 135 degrees Fahrenheit: <br /> [ Camp Stove [ Double steamer [ ] Electric stove top <br /> [ ] Sterno& hotel trays [ ] Steam table & lids [ ] Other(specify): <br /> Note: Examples of potentially hazardous food include: meats,tamales, cooked beans,rice vegetables, <br /> potato salad,eggs and dairy products. <br />