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REC-008 <br />SAVJOAQUIN Environmental Health Department <br />CdfUNTY r-4 C.\ \2-5:1' \ , CC.5C7n <br />ex[11(5 JIotv5 hure. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for prof ii 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 />Music in the 1.Name of Event: <br />The following Is information about my organization/business: \LC; <br />Name of organiz\.ation/business: <br />Address: <br /> `16j tkout L.,0 14/16 <br />Phone: 650 ,- 04 <br /> <br />Alternate: co 2-7a - ?-111q, <br /> <br />List food to be sold or given to the public: 7Y) et) a 11 )0 4 < 0/gq1 'TeA keyais 0 c . <br />I am providing food that is NOT prepared at home: es <br />All food is prepared on-site or is from approved commercial racilities:K fr0 LI3o <br />Name of facility: Phone: <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 />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and line mesh fly <br />scr ening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean larps 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />I-'-pproved bottled water. <br />rThin-site hose bib that is connected 10 a potable water source. <br />Date(s): 9/ o//2o 14 <br />Pther (specify): <br />ectricity is provided for my booth's use <br />I am providing an accurate probe the <br />foods during all times of booth operation <br />I am providing the following hot iemperatu <br />No <br />asure the hot and cold holding of potentially hazardous <br />contro the hot holding of all potentially hazardous foods above <br />q5°F: <br />amp stove <br />ouble steamer <br />lectric stove top <br />pS , 'terno & hotel trays <br />Steam table & lids <br />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 loft i TEMP EVENT APP <br />OBI 9119