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t <br /> SA JOAOUIN Environmental Health Department <br /> -_0UNTY-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a s€pvd and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: Dale(s): <br /> 2. The folowing is information about my organization/business: <br /> Name of organizatlonfbvsinesls�: q <br /> Address: _ �7 .j ! rU/�C/ I TC� f f 5 5_7 <br /> Phone: (SRO ) �Jlt 1 Alternate:(5M O 15 <br /> 3. last food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:®Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities: ®Yes❑No t <br /> Name of facility- Phone:f 7- - `IS ?O <br /> Address of facility. QVt7 C-q C YA `SS Z oS <br /> 6. 1 am providing a booth with the following: (to protect myJjhpacka6ed food and food-preparation areas from Hies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of efther 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): �_��- r o c�c� r�!� - - - ---- - <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. E <br /> r• <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), kv._, 1F,v c A(- 7 'ta lT , a <br /> 7, Electricity is provided for my booth's use:K Yes ED No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:®Yes❑No ib <br /> 9. 1 am providing the fotlowng hot temperature control for the hot holding of all potentally hazardous foods above <br /> 135`F: <br /> ❑Camp stave ❑Stern&hotel trays <br /> ❑Double steamer ❑Steam table i3 Ilds <br /> ❑Electric store top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meals, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton. Califomia 95205 1 T 209 468.3420 1 f 209 464-0 138 1 WWw.5Jgov.or91ehd i <br /> EHD 10,W Pfye 7 rd tt TFUP EVENT&Pp <br /> 0&2V4L3 <br />