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<br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY — <br />"iiiMed# <br />woe, <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: ai1 j L1 +1-e ?ctr .< Date(s): (I, 20 <br />The following is information about my organization/business: <br />Name of organization/business: Cc B G. <br />Address: L\--1 CI C) ek kc bc. <br />Phone: ( ) <br /> <br />Alternate: (2" ) <br /> <br />5 c/Li- 3 <br /> <br />List food to be sold or given to the public: V. 0 Tit AiV) A)S <br /> <br />I am providing food that is NOT prepared at home: [N_ Yes E1 No <br />All food is prepared on-site or is from approved commercial facilities: pi. Yes 0 No <br />Name of facility: T i 9 -t) i 1111: 1k .\-3j0C\ Phone: (e Vel )2-Li II -f 1-3 ce <br />Address of facility: -1)()S- 2-- \_,kJs --- Lc16 e 4 c LI A- - 13 <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 />116--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 />El 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 />laApproved bottled water. <br />El On-site hose bib that is connected to a potable water source. <br />El Other (specify): <br />Electricity is provided for my booth's use: El Yes a 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: Ii 1,Yes El No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Ej Camp stove gSterno & hotel trays <br />111 Double steamer El Steam table & lids <br />El 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 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