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Environmental Health Department <br />Jatefs): <br />2. <br />(2/7 <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209468-34201 F 209464-0138 I www.slcehd com <br />Page/olll TEMP EVENT APPUz/<3/l / <br />SANJOAQUIN <br />-----COUNTY------ <br />Gri'nlness tjrm.,1; her:1. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Pro^and non-profit) are required to return a signed and completed copy of this checklist to <br />I.Name of Event:z z r // falknl falwr <br />The following is Information about my organizatlon/business: <br />Name of organizatlon/business: Ct/enH-g <br />Address: 73Y/ /hr, syJd- Vg> <br />Phone: Alternate^ ). <br />List food to be sold or given to the public: /&£&&, fButti (es, sdt*, a <br />I am providing food that Is NOT prepared at home: 0Ves No <br />All food is prepared on-site or Is from approved commercial facilities: OYes No <br />Name of facility: 72zz> Rhone: ) 5C 5-652^ <br />Address of facility: ^^7 s/ Crf gf-fCy <br />1 adustrand th9 p W'th 1 1 9: Protect my unpackaged food and food-preparation areas from files, <br />E'X booth with walls and celling consfructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />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 />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />©Approved bottled water. <br />O On-site hose bib that Is connected to a potable water source. <br /> Other (specify):_________ <br />Electricity Is provided for my booth's use: ©Yes No ——————— <br />I am providing an accurate probe thermometer; to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ffires Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F: <br />©tJamp stove sterno & hotel trays <br />©Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.