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SAN JOAOUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datefs). 1. <br />2. <br />Address:I <br />Phone: <br />3. <br />4. <br />5. <br />a <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />O Approved bottled water. <br />7. <br />8. <br />9. <br /> A booth with walls and ceiling constructed of either wood, canvas, {Mastic, similar material end fine mesh fly <br />screening, completely enclosing open food areas. It will also havp-a-emoolh and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and con^fruded to separate food and food preparation <br />areas from the public. * -I H x I f / \ <br />gqOther (specify): YVAdV?<L^ ./ <br />Note: The only operations not required to provide enclosed booths^relfibsFwhidisell beverages fron^ T~ <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 P*®* 7 o* 11 TEMP EVENT APP <br />07/01/2024 <br /> Stemo & hotel trays Steam table & lids <br />O Other (specify) A .□ A/|A <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at homejjjjj Yes No <br />All food is prepared on-site or Is from approved commercial fadlitiesgj Yes No <br />Name of facility: I Phone: ( ) ______ <br />Address of facility: ___ __ <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 />Q On-site hose bib that is connected to a potable water source. <br />rfi. Other (specify): <br />Electricity Is provided for my booth's use: 0 Yes QNo <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during al) times of booth operation Q Yes 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 /> Camp st ove <br />O Double steamer <br />0 Electric stove top <br />All food vendors (both for profit end 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 organizalion/buslness: <br />Name of onganization/business: <br />(2</1) I# __ Alternate: ( ) . <br />List food to be sold or given to the public:. ice ________.