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SAN JOAQUIN <br /> <br />Environmental Health Department <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: cci I 5 <br />The following is information about fl1A y organization/business: <br />Name of organization/business: if v U'L-- )C16) LiC-i4 \t,s <br />r f\-VAel ify <br />Phone: ( ) -9 Co - Alternate: ( ) <br />List food to be sold or given to the public: ‘2, -X. r" <br /> <br />I am providing food that is NOT prepared at home: EKes D No <br />All food is prepared on-site or is from approved commercial facilities: Yes 0 No <br />Name of facility: C\--Pc-9-, Phone: PCJj <br />Address of of facility: 7- \Th3 PC\ Pc-v-4-iy-\ Rtbio•-vci C-Pr <br />I am providing a booth with the following: (to protect my uhpackaged food 41.-ip food-preparation areas from flies, <br />dust and the public) <br />FA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />eening, 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 />FAApproved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's use: j 1 Yes No <br />I am providing an accurate probe thern ometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: n Yes 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 />Camp stove j6Sterno & hotel trays <br />Double steamer 0 Steam table & lids <br />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 />El-ID 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19 <br />Date(s): <br />Address: