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SAN;JDAQUIN Environmental Health Department <br />_ <br />—COUNTY— <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR'S APPLICATION <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 />1. Name of Event: River Islands Certified Farmers' Market <br />2. The following is information about my <br />Date(s): Saturdays 8:30 to 123 <br />Name of organiizza�trioon7/-b-'u�siness: I <br />Address:Wrf '10i <br />Phone: c5��) M - D (Alternate: <br />3. List food to be sold or given to the public: <br />4. 1 am providing food that is NOT prepared at home: MYes ❑ No <br />All food is prepared on-site oris from approved commercial facilities: M' -Yes ❑ No 00-31-0 <br />Name of facility: Phone: ( 1 <br />Address of facility: <br />5. 1 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 />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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />❑ Approved bottled water. <br />)�On-site hose bib that is connected to a potable water source. <br />❑ Other (specify): <br />7. Electricity is provided for my booth's useX Yes ❑ No <br />8. 1 am providing an accurate probe thermog 2ter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operatio ' Yes ❑ No <br />9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />❑ Camp stove Sterno & hotel trays <br />❑ Double steamer ❑ Steam table & lids <br />❑ Electric stove top ❑ Other (specify) <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue I Stockton, California 952051 T 209 466-3420 j F 209 464-0138 1 www.sjcehd.com <br />EHD 18-02 Page 7 of 11 TEMP EVENT APP <br />