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Name of organization/business: 1/42-1 A 14-41-tht 0-,12)M1tL <br />Address: <br /> <br />41e^"Ir AWE <br />SAN JOAQUIN <br />Environmental Health Department <br />COUNTY <br />Greotnss •re. <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.oi P I. Name °t- Event: 9°T) cz64- - 61 a— Date(s): /14 —et d <br />2. The following is information about my organization/business: <br />Phone: ( 201 ) '334 Sttrp <br /> <br />Alternate: ( 2-01 ) ego 7 <br /> <br />List food to be sold or given to the public: 6N ati-t L ILE ri , &IL q140 I 9Pro-tolA, CAJIZR-1._ <br />I am providing food that is NOT prepared at home:126'es No <br />All food is prepared on-site or is from approved commercial facilities: ErYeS D No <br />Name of facility: Phone: (201) 6 IS 3 2-1 <br />Address of facility: <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 />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 />o 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 />proved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use: Eces 0 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: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />D Camp stove LI Stemo & hotel trays <br />0 Double steamer 0 Steam table & lids <br />0 Electric stove top ErOther (specify) C. WO -40r 4(2.i <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 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 <br />06/29/2023 <br />Scanned with CamScanner