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71‘: SAN JOAQUIN <br /> <br />Environmental Health Department <br />UPV —COUNTY <br />Grentr"- <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit arid non-profit) are required to return a sighed and ccxnpillied copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />1.Narne of Event. 01ttie1j 'ram 3/-9/dae.S <br />The following is informatIon about my arganizalionibusamesc <br />Name of organizatonfbusiness: )(pszAti6,-) Set,r2s\-s <br />Address: 19 (4i° e-k- c2461 <br />Phone: Ta`a Ic,cic Alternate: ( ) <br />List food to be sold Of given to the p Utak <br />.1. I am providing food that is NOT prepared at home: Kees 0 No <br />All food is prepared on-site or is from altproved commercial facilities.V5Yes No <br />Name of facility J tel" Phone. ( Al 1,4 <br />Address of facility: <br />I am providing a booth with the following: Ito protect my unoackaged food and food-preparation areas from flies. <br />dust and the putilci <br />%Lk booth with waits and ceiling constructed of either wood. canvas, plastic. srnilar matenal and fine mesh fly <br />screening. completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete. <br />asphat clean tarps and smooth wood are acceptable) and constructed to separate food anc food preparation <br />areas from the public. <br />fl Other (specify): <br />Nate: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers. or prepackaoed foods from approved sources. <br />Approved water for drinking, utensil and hard washing will be provided in my booth by the following methods_ <br />pproved bottled water. <br />Wn-sle hose bib that is connected to a potable water source. <br />0 Other specify': <br />Electricity is provided for my booth's use:54es 0 No <br />I am providing an accurate probe thermometer to measure the hot anC cold hotting of potentially hazardous <br />foods clunrig all trnes of booth operationF94es No <br />I am providing the folowing hot temperature control for the hot holdird of all potenbally hazardous foods above <br />135"F. <br />CI Camp stove Stemo & hotel trays <br />Double steamer eSteam table & lids <br />$41earic stove top 0 Other !specify) <br />Note: Examples of potentially hazardous food include: meats tamales, cooked bears, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E Fiazekon Avenue l Stockton. California 45205 1 T 209 468-34201 F 209 464-0138 I www.sigov.orgrefid <br />DO 16412 Page Tet 11 TEMP EVENT APP <br />07/01=4