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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />TEMP EVENT APP <br />7. <br />8. <br />9. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />C A_ ->1^. 7 & Cs> <br />i areas from flies, <br />SANJOAOUIN <br />------COUNTY------- <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />1 -rrt in /r HT <br />EHD 16-02 Page 7 of 11 •—••• — •• <br />07/01/2024 <br /> Sterno & hotel trays Steam table & lids <br />IZ1 Other (specify) <br />W ■ <br />r ' <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />iree (3) weeks prior to this event. J/ I- <br />1. Name of Event: iT x 6\A>^ate(s):------------------------- <br />The following is information about my organization/business: <br />Name of orqanization/businesSTy <3^10 ^> / A /VbfX-C <br />Address: ■ (P I <br /><2^ Alternate: ( ) <br />List food to be sold or given to the public:~.T"' L <br />I am providing food that is NOT prepared at homeQ Yes No <br />All food is prepared on-site or is from approved commercial facilities^ Yes No <br /> Name of facilitYTy^C^Phone: (2 601__4"~7 & ' <br />Address of facility: <, -7 CV^'T1 v~\ ( A <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation <br />dust and the public) <br /> 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 />□ other (speedy z/ I 44 5? J <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 /> 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 operatiorxQ 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 /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.