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Environmental Health Department <br />*7 Date(s): <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />s’ <br />9. <br />SAN JOAQUIN <br />------COUNTY- • • <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ^.sjgo^org^hd <br />EHD 16-02 Page Zoin <br />07/01/2024 <br />All food vendors (both for profit and non-profit) are required to return <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: \ -----------——------------------------- <br /> fl'N Wvyiiv^vn- WiVWcc/L cm ' — <br />(JAA) - Alternated )__------------------------------------- <br />List food to be sold or given to the public:.. S'tW <br />I am providing food that is NOT prepared at homeCJ Yes E^No <br />All food is prepared on-site or is from approved commercial facilitiesQ Yes 0 No <br />Name of facility:—-----------------------Phone. {--------) <br /> fam providing a^Soth with the following: (to protect my unpackaged food and food-preparation areas from flies, <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 />areas from the public. <br />Other (specify): 4WV <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 /> On-site hose bib that is connected to a potable water source. <br />SfOther (specify): 0/^------------—-—==-----------—--------------------------------------------------------------- <br />Elnm^XV- hOt and CO,d hoiding of “us <br />I am°providing IhL^towTng h^tempSaturPcontrol for the hot holding of all potentially hazardous foods above <br />135OF’ <br /> Camp st ove Stemo & hotel trays Steam table & lids <br /> Double steamer Other (specify) <br /> Electric stove top D <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.