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SAN JOAQUIN <br />COUNTY <br />Environmental Health Department <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] t-cd'6 1,(///t -C- C )(leir;146-- Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: )90116- eM5 <br />Address: fe-e- AV-r Z-aR'r <br />Phone: (W) 2-7 019 Altemate: ( <br />List food to be sold or given to the public: 1.11',1' PIC-1; Ca- <br />I am providing food that is NOT prepared at home: Mies CI No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: '1,14 61,ii-e)- X fc-e-/'("a'fr-7--- <br />Address of facility: 7-i {71 (4: FiLq._ <br />I am providing a booth with the following: (to protect my unpackaged <br />dust and the public) <br />O 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 />El Other (specify): <br />Note: The 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 drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled water. <br />Ej On-site hose bib that is connected to a potable water source. <br />'gOther (specify): <br />Electricity is provided for my booth's use:ErYes Li 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 operation: Vi Yes Li No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Li Camp stove Li Sterno & hotel trays <br />Li Double steamer FiSteam table & lids <br />O Electric stove top E(Other (specify) (f01 etx <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 Stockton, California 95205 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06119/19 <br />E Yes O No <br />Phone: ( ) <br />vt-r77 <br />food and food-preparation areas from flies,