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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUN7Y <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: St Cge--\-- s. (2--OR Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: \I! iCA19(13 0( Arelv,k -T\rak,9 <br />1$0(\ rOkr-ei Gra - <br />Phone: (r5tO )1(*' 1(g.0 <br /> <br />Alternate: ( <br /> <br />List food to be sold or given to the public: C-Oc bOtA -t7,(_) <br />I am providing food that is NOT prepared at home: .Yes El No <br />All food is prepared 21-5ttesr is from approved commercial facilities: gf Yes El No <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 />V:1 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 />0 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 />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: El YesNo <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: gYes D No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />El Camp stove OSterno & hotel trays <br />D Double steamer El Steam table & lids <br />lectric stove top Other (specify) Ckak gri - <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 952051 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 />06/19/19 <br />Address: