Laserfiche WebLink
Environmental Health Department <br />1. Name of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />the hot and cold holding of potentially hazardous <br />9. <br />7. <br />8. <br />® Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />List food to be sold or given to the public: <br />Steve. <br />meats, tamales, cooked beans, rice, <br />SANJOAOUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />” » are those which sell beverages from <br />sources. <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved sclt <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />I am providing food that is NOT prepared at home: B Yes O No <br />All food is prepared on-site or is from approved commercial facilities: 0 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. <br /> Other (specify):______—------------ <br />Electricity is provided for my booth's use: O Yes U No <br />I am providing an accurate probe thermometer to measure <br />I am°providing hot bolding of aH potently hazardous foods above <br />135°F- <br />E Camp stove Sterno & hotel trays <br /> Double steamer E3 Steam table & lids <br /> Electric stove top B Other (specify) M <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420 | F 209 464-0138 | www-^org/ehd^ <br />EHD 16-02 Pa9e ° <br />06/19/19 <br />All 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 />51; Maw *5 iTTmily f^jj~iiral ___Date(s):. R Uj iu-l~ / <br />The following is information about my organization/business: <br />Name of organization/business: LS 4 l~\^------FY 3 3 iXbA I 0 ,Q---------(L CCH <br />VD'2, £7 sT SVocMon__(Kfi. <br />~~ bl ____________ Alternate: ( H 1 __/L0 ------- <br />/-ilipino H>od___________________