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Environmental Health Department <br />/P-JV-2D/7Date(s):1. <br />2. <br />Address:+ <br />Phone: <br />3. <br />4. <br />iido <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />7. <br />8. <br />SAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />A o-f <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />1 . Tr-»ino/rinEHD 16-02 Page 7 of 11 • —••• — <br />07/3/17 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: Li nrl/YI Bafld <br />PT). &QX lioV Lmden , ffl. ______________ <br />(2-B>A ) 7 /7a Q?- Alternate: ( ) <br />List food to be sold or given to the public: drcdrijOursj-. ppWoscdrfrd. App ks , camneJ <br />0Yes No <br />_ Phone: (2.^9) 7 " <br />WrsQ L/nckn _______ <br />I am providing food that is NOT prepared at home: Q^Yes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: Of f-DCl l) <br />Address of facility: j _____, <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />0 A booth with walls and ceiling constructed 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 />H^Other (specify): ndA'im Cows cofidWnk______________ <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 /> On-site hose bib that is connected to a potable water source. <br />0Other (specify): dcivd IQ, <br />Electricity is provided for my booth’s use: CT Yes Q^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: 0Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: r-D <br /> Camp stove EJSterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify)