Laserfiche WebLink
Environmental Health Department <br />i. <br />2. <br />Phone: <br />3. <br />4. <br />approved coi <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />I am <br />All food is preparei' <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 />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 />7. <br />8. <br />“'Xyi Sterno & hotel trays <br /> Steam table & lids <br />Q Other (specify) <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APR <br />06/19/19 <br />SAN JOAQUIN <br />——COUNTY ...- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <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 />Note: 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 /> Other (specify):x___________________________________________________________ <br />Electricity is provided for my booth’s usX|/l Yes H 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 operations^ Yes 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 <br /> Double steamer <br /> Electric stove top <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />1. Name of Event: 64- S W wLte.sfl jt U ~ I P) / > <br />The following is information about my organizatibn/business: <br />Name of orqanization/business^^ <br />Address: 6C>S'E’. ^0^)4 ^4 C'A <br /> Alternate"2P^ > 3^45^ <br />List food to be sold or given to the public: <br />providing food that is NOT prepared at home: E Yes No <br />ad on-sitexir is from approved coramerojal facilities^H Yes No <br />■ ' ^pJHerL^ne:m 913^613, <br />.....kJ. doje,. CA 952^^