Laserfiche WebLink
SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event: Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />7 Gxl^T <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />JSJ Approved bottled water. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br /> On-site hose bib that is connected to a potable water source. <br />^0] Other (specify): <br />Electricity is provided for my booth’s use: Yes"Q 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/© No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />fl Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Name of organization/business:J <br />Address: <br /> Alternate: ( ) <br />List food to be sold or given to the public: / <br />I am providing food that is NOT prepared at home: Yes"^ No <br />All food is prepared on-site or is from approved commercial facilities: Yes^ No <br />Name of facility: __________________________________ Phone: ( ) <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. n I <br />H Other (specify): / r\ <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | vwvw.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APR <br />06/19/19 <br />AH 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 />rn rtcjy________ <br />The following is information about my organization/business: