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SAN JOAQUIN co N v <br />Environmental Health Department <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. 1. Name of Event: Peto125A 1A141.)1 -) A A kit) Duk 601 PujA )e)i-ff Date(s): Lt f -6/` °c 1 tit <br />The following is information about my organization/business: <br />Name of organization/business: DON1..54 SwcEV. /,‘ 1,4) Qes7pu EA kir <br />Address: 3310 t4 Macy Bc...vD #1> 114cl C_A — 311 <br />Phone: (2o'1 ) 20 1- Ig Alternate: ( <br />List food to be sold or given to the public: C ko A ,jP-4 Pk.) 5 A43 9A..‘talA egqo <br />tAre-75, pp,,Di t1414-7 <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: poisb S EC TS Efs7Pog-A-NT Phone: (2,1 ) I-44 7 4 1Z <br />Address of facility 13 10 IJ Tekcy 13t...vo 44 , ?t,t-e.t a— et 01 I <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 />El 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 />Cl 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 />El Approved bottled water. <br />El 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: 0 Yes 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 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove fi4) Stemo & hotel trays <br />El Double steamer El Steam table & lids <br />0 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 />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 j 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