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2/506-23-16;11:02AM;STOCKTON CERTIFIED FARMERS MAR <br />J'JW 4 3 * <br />Date(s): I.Name of Event:1. <br />2. <br />Name of organization/business: <br />Address: <br />Alternate: () Phone:( <br />List food to be sold or given to the public: 3. <br />4. <br />1 <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 />O Other (specify): <br />7.Electricity is provided for my booth's use:, <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Paso 7 Of 11 TEMP EVENT APR <br /># <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />I am providing an accurate probe themnometi <br />foods during all times of booth operation: FT? <br />0bterno & hotel trays <br />O Steam table & lids <br /> Other (specify) <br />a; to measure the hot and cold holding of potentially hazardous <br />Yes D No <br />3ves No <br />Phone: (___ <br />EHD 1S-02 <br />11/4/14 <br />Received Time Jun. 23. 2016 10:58AM No. 0913 <br />C 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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0Camp stove <br /> Double steamer <br /> Electric stove top <br />o <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 />’es No <br />The following is information about my organization/business: <br />c\5 CcxW_______ <br />TEMPORARY FOOD VENDOR’S APPLICATIC^viro^ental health <br />PERMIT/SERV1CES <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 />C Date(s): <br />- OVED <br />I am providing food that is NOT prepared at home\0 Yes No <br />All food is preparedon-sltepr is from approved commercial facilities: <br />Name of facility: <br />Address of facility: