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SAN JOAQUIN <br />Environmental Health Department <br />— -COUNTY -- <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.Name of Event: Poo R.611 1)/),..i, 11 A At-NipUf1.,c 4 P03 A- 7- 1/ Date(s): 6 7 )1 7 / 2-1/ <br />The following is information about my organization/business: <br />MOtA 'JCL'I Y1 114 ()1 2 Q2 <br />Address: k 961 1 (V\ nu y1/44-0 iOtW. ft'7 , fVILJII 4W ,C 5 <br />Phone: ( )2`?i! an L . _ . _ . . _ Alternate:( <br /> <br />List food to be sold or given to the public: ei 2_2- A <br />I am providing food that is NOT prepared at home: Yes LI No <br />All food is prepared on-site or is from approved commercial facilities: [Yes LI No <br />Name of facility: IVVT wr,e,k ei2_, A Phone: ( <br />Address of facility: As bave <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 />LI 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 />LI 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 />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: Yes 0 No <br />I am providing an accurate probe therm meter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: q Yes 11) 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 CiSterno & hotel trays <br />0 Double steamer O Steam table & lids <br />0 Electric stove top 0 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 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />nn IflOdflflhl <br />Name of organization/business: <br />Scanned with CamScanner