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REC-DOS <br />SA JOA UIN <br />Ilmental Health Department <br />—COUNTY— <br />Greatrits co-ovy.s here, <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 />Music in the 1.Name of Event: Date(s): 9-21-24 <br />The following is information about my organization/business: <br />Name of organization/business: CA 114-€ <br />Address: 9 ti rbri j 0;.o £, €_ Allovollo A 1-1-"--14 ;e' `i-5 3` <br />Phone: t c-) li (?ft' Alternate: <br />• <br />List food to be sold or given to the public: CA/LA/N(1(57/ C,4.2 k— (Ai\ <br />I am providing food that is NOT prepared at home: es <br />All food is prepared on-site or is from approved commercial facilities:ft <br />Name of facility: CA Y--I---e._ V". C 1 )( <br />Address of facility: c1 1:7 t,„) . Or ei (,2:1,0 ( e-,2 i'- <br />I am providing a booth with the following: (to protect my unpackaged <br />dust and the public) <br />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 />[721t her (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 />DApproved bottled water. <br />rlDn-site hose bib that is connected to a potable water source. <br />Pither (specify): <br />ectricity is provided for my booth's use .j Ye No <br />I am providing an accurate probe the -r i. -asure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation es o <br />I am providing the following hot temperature cintro T. the hot holding of all potentially hazardous foods above <br />15°F: <br />amp stove <br />,ouble steamer <br />leolric stove top <br /> <br />Sterno & hotel trays <br />Steam table & lids <br />Other (specify) <br /> <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 Stockton, California 95205 i T 209 468-3420 I F 209 464-0138 I wvvw.s.igov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />e o <br />Phone: eli — <br />1S)( <br />food and food-preparation areas from files,