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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 />) <br />3. <br />4. <br />5. <br />which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Note: <br />7. <br />8. <br />pter to measure the hot and cold holding of potentially hazardous <br />hot holding of all potentially hazardous foods above <br />SAN JOAQUIN <br />------COUNTY------- <br />Greotness prows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />209 464-0138 | ^ww.sjcehd.c^m1868 E. Hazelton Avenue | Stockton, California 95205^^209 468-3420 | F <br />EHD 16-02 <br />07/3/17 <br /> Date(s): _L <br /> Other (specify):---------------------------------------------------------------- <br />N°tG: ^X^eddis^em^ <br />AP(ra« <br />[3 Approved bottled water. <br />)£j On-site hose bib that is connected to a potable water source. <br />I providing an accurate7 probe thermometer to meas, <br /> camp stove Stemo & hotel trays <br /> Double steamer O Steam table & lids <br /> Electric stove top other (sPeclfy) <br />Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: fYn5 fYCGUS. <br />The following is information about my organization/business. <br /> <br />Name of organization/business: <br />Address: ---------- <br />Phone: (CMl) --------------------------- A" ( <br />List food to be sold or given to the public: ~>DO (. ------- <br />I am providing food that is NOT prepared at home: ® Yes No <br />AH food is prepared on-site or is ------------------- <br />Name of facility: TaH ACS —--J ’ zx. CtfSCVCX t <br />dust and the public) <br />fa A booth with walls and ceiling constructed of either agmooth^n^ cleanable floor (concrete, <br />Ts- -ePtab-e) and constructed to separate food and food preparation <br />areas from the public.