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S A N J O A Q U l N Environmental Health Department <br /> couN v <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 pnor to this event. <br /> 1. 1.Name of Event `• L�Gt , CC) Date(s), �8 -2 <br /> 2 The following is information about my organization/business. <br /> Name of organization/business: F (-, (Z r—)5; �/­, <br /> Address: 15�( Z R ( e -,^l,r ✓L k -a "e_ <br /> Phone -tc S e ,,I Alternate ( ) <br /> 3. List food to be sold or given to the public. r�c � _l <br /> 4. 1 am providing food that is NOT prepared at home ❑ Yes 3#0 <br /> All food is prepared on-site or is from approved commercial facilaties:.rYes ❑ No <br /> Name of facility: Phone <br /> Address of facility. <br /> 5. 1 am providing a tooth with the following (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> 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 /> Notre: 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 /> proved Mottled 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 use: Sdes No <br /> 8, I am providing an accurate probe thermolFrieter to measure the hot and cold holding of potentially hazardous <br /> foods during all tines of booth operation,-E Yes[]No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially hazandous foods above <br /> 13VF: <br /> ❑Camp stove ❑stemo&hotel trays <br /> ❑ ble steamer ❑steam table&lids <br /> Elechic stove top ❑Omer(specify) <br /> Nob.,,Examples of potentially hazardous food Include: meats, tsmahs, cooked beans, rice, <br /> goes,potato salad,*M,and dairy products. <br /> 11868 E Hazelton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 1 www sigov.orgtehd <br /> M s-os <br /> vo.7 of 11 ro+e 11DArr'I'A" <br />