Laserfiche WebLink
Environmental Health Department <br />Date(s): 1. Name of Event:1. <br />2, <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />-x SANJOAOUIN <br />'■'I ------COUNTY------ <br />Greatnesi grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />EHD 16-02 Page 7 of 11 TEMP EVENT <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 /> Date(s): <br />\ ! <br /> On-site hose bib that is connected to a potable water source. <br />Yj 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 operation: 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 stove Sterno & hotel trays <br /> Double steamer ’ WSteam table & lids <br /> Electric stove top Other (specify) <br />The following is information about my organization/business: <br />Name of organization/business:f~~£/L37'' <br />Address:C <br /> Alternate^ ) <br />I am providing food that is NOT prepared at home:'^f Yes No . <br />All food is prepared on-site or is from approved commercial facilities: K] Yes No <br />Name of facility: <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 /> 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 (specify): <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: