COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

10/15/2021 14:35 91648402bw CARMICHAEL SOX Sk. PAGE 02 SAN 10AQUIN Environmental Health department CC)l..INTY----- TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit)are required to retum a signed and completed copy of this checklist to the festival 000rdinator three(3)weeks prior to this event. h 1 1.Narno of Event; // al,4,5;- _ Oate(s): C1 2. The:following is Informetbri about my organization/husinass: Name of organlzallorl/businssx: I Address: Phone: (�/�J 1 47� - Alternate: 3. list food to be sold or given to the public:^ �- 4. 1 am providing food that is NOT prepared at home: 2fYes{]No All food is prepared on-site or is from a proved commercial fscilili+st3:(jYes ElNo Name of facility: ✓ _, _phone: Address of facility: _ 5. 1 am providing a booth with the following: (to protect my tunpackwjext food and food-preparation areas from Was, dust and the public) Z A banlh with-.ails and ceiling constructed of either wood, canvas, plastic, similar material and One mesh fly screening, completely enclosing open food areas. It 411 also have a smooth and cleanable floor (concrete, asphalt, clean tarps acid smooth wood are acceptable) arid constructed to separate food and food preparation areas from the public. ❑Other(specify): — Note: The oniy operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking,utensil and hand washing will be provided In my booth by the following methods: Approved bottled water. A On-site hose bib that Is connected to a potable water source. ❑Oftr(specify): — 7. Electricity is provided for my troth's use: Yes No 8. 1 am providing an accurato probe thermom r to rneasure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes❑ No 9. 1 am providing the following hot temperate control for the hot holding of all potentially hazardous foods above 135"F: ❑camp stove ❑stemo$hotel trays C]Double steamer ❑Steam table&rids []Electric stove top �--other(specify) �t Note: Examplos of potentially hazardous rood include: meats, tamales, cooked boards, rigs, vegetablen,potato salad,eggs,And dairy products. 1068 E. Hazeiton Avenue , Stockton, California 95205 1 T 209 468-3420 1 F 2.09 464-01.38 1 www.sl�ov,org/ehdPP HH6 1"2 Page 7 nr 11 W11W1G