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<br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />reotness ,_7r4.-.Gys 1'7 <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Zeig , T/13, <br />1. Name of Event: /1/ e Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: pi - Shic.„7/ <br />Address: a j31/0 %Sie- 7,7(r/ak q5-3.5.0 <br />Phone: ) 9f22'4'5 <br /> <br />Alternate: ( <br /> <br />List food to be sold or given to the public: leee-4 eitie-keri 72 54-4- get7e/al4iie.4 A ar,--(-2L <br />I am providing food that is NOT prepared at home: X Yes E No <br />All food isErzpared on-site or is from approved commercial facilities: rgi Yes 111 No <br />Name of facility: /-1,(7 _fia_._ 76).-'we,e4 Phone: (,./Oq ) 599 <br />Address of facility: /.4%.6, t -Zeer eel Ti po.d <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 />Lii 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 />• <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />21 On-site hose bib that is connected to a potable water source. <br />Other (specify): (42/77e,t &,latAler- <br />Electricity is provided for my boot s use: [Z] Yes No ii)/e.''Rei /el e <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: Is Yes 111 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove Sterno & hotel trays <br />El Double steamer El Steam table & lids <br />LI Electric stove top El Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <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 />1868 E. Hazelton Avenue I Stockton, California 95205 I 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