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i <br />SAN JOAOUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1._ Date(s): <br />2. <br />¥ <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />6. <br />the hot and cold holfifng of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />iNo <br />measure <br />7. <br />8. <br />Alternate: (^Q) ?o^-5n3 <br />1368 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0133 ! ww,/.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />The following is information about my organization/business: <br />Name of organization/business: ?v DM <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />STl Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):.______________________ <br />Electricity is provided for my booth's use: Yes <br />I am providing an accurate probe thermometer to n <br />foods during all times of booth operation: Q Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ip5°F: , <br />E3 Camp stove Sterno & hotel trays <br />O Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />required to return a signed and completed copy of this checklist to <br />'SUMM-'ls <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 />£_J 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 />All food vendors (both for profit and non-profit) are i ’ ’ ' <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: <br />I am providing food that is NOT prepared at homeXJ Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes 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 />du^tand the public)