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Environmental Health Department <br />All food vendors (both for profit and non-profit) are required to return <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br /> Sterno & hotel trays <br />Steam table & lids <br />Q Other (specify) <br />• •• r hazardous food include: : v^Z^s/pot^’saladfeggs, and dairy products. <br />209 464-0138 | www.sjcehd.com <br />TEMP EVENT APP <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Pl AVd-f O CaTCUlS. <br />The following is information about my organization/business. <br />Name of organization/business: SfcUQr --------------------------- <br />f^rCi'rOtex PC 2542X1-------- -------------- <br />Phone: (QMI) ( -------------------------------- <br />List food to be sold or given to the public: -1------------" <br />I am providing food that is NOT prepared at home: $ Yes No <br />All food is prepared on-site oris from approved commercial facilities: $ Yes No <br />Name of facility: ------------------- <br />dust and the public) <br />to A booth with walls and ceiling constructe d ^lther g smooth™!^ deniable floor (concrete7 <br />— Xd am a^abie) and constructed to separate food and food preparation <br />areas from the public. <br />1868 E. Hazelton Avenue | Stockton, California 95205,1 1,209 468-3420 | F <br />EHD 16-02 <br />07/3/17 <br />SAN JOAQUIN <br />------COUNTY------ <br />Grentness prows nere <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <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: <br />Q Approved bottled water. <br />yj On-site hose bib that is connected to a potable water source. <br />I X^idi^aneacS ^oteS^ter to measure the hot and coid holding of potentialiy hazardous <br />! am"n^ ^e — g’S^Klr the hot hoiding of ail potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />Date(s): X