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,`:.. SA N J OAQ U I N Environmental Health Department <br /> r,,:,r+�`Y �Icutrt<'as <�rntvc Ili'rf. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit ar}d 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 /> Lodi comjc con Dates 9/28/24 <br /> 1. 1.Name of Event: ( ) <br /> 2. The following is information about my organ izationlbusiness: <br /> Name of organization/business: _ Nana Bears Midi Donuts <br /> 680 Town Square <br /> Address: <br /> Phone: ( 510 ) 3049350 Alternate: ( ) <br /> 3. List food to be sold or given to the public: Mini Donuts, <br /> 4. 1 am providing food that is NOT prepared at home: f3Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities:Wes❑ No <br /> Name of facility: nla - All food prepared on-site 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 /> X 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. tt 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 /> XApproved 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 user Yes ❑ 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 <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1359F: <br /> Camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑ Electric stove tap ❑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 209 468-3420 l F 209 464-0138 j www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 0713117 <br />