Laserfiche WebLink
Environmental Health Department <br />Date(s): 1. <br />2 <br />3. <br />4 <br />5 <br /> Other (speafy) <br />G. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />moats, tamales, cooked beans, rice,Note: <br />7. <br />8. <br />1868 E. Hazelton Avenue | <br />FHD 16-02 <br />06H9H9 <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 dnnkmg. utensil and hand washing will be provided in my booth by the following methods: <br />^^Approved bottled water. <br />SANJOAQUIN <br />C OU XJTY-- <br />■ c i( " qrniv, he re <br />TEMPORARY FOOD VENDOR S APPLICATION <br />Stockton California 95205 | T 209 468-3420) F 209 464-0138 | www.Sjgov.org/ehd <br />Page 7 of 11 TEMP EVENT APP <br /> Other (specify):________________. ________________________________________________________ <br />Electricity is provided for my booth's use: [YYes No <br />I am providing an accurate probe thermofneter 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 />135OF: <br /> Camp stove Stemo & hotel trays <br /> Double steamer □Steam table & lids t <br />□ Electric stove top toother (specify) "VO 0V-c <br />Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist lo <br />the festival coordinator three (3) weeks prior to this event <br />I .Name of Event: U QF (PjLOV>'\ LXkVgv <br />The following is information about my organization/business <br />Name of organization/business: <br />Address: <br /> Phone <7^) Alternate: (7^) <br />List food to be sold or given to the public: ^TMJLS ) CaVCS.-------- <br />I am providing food that is NOT prepared at home: i^Yes □ No <br />All food is prepared on-site or is from approved commercial facilities:'|^Yes No <br />Name of facility Vfr 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 />sveemng, completely enclosing open food areas It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.