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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1. <br />2. <br />Name of organization/business: <br />Address:+ <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />meats, tamales, cooked beans, rice, <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />------COUNTY------- <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | vvww.sjgovWehd^ <br />EHD 16-02 Page 7 of 11 <br />06/29/2023 <br />7. <br />8. <br />9s" <br />-4— <br />^^^mate: <br />iz —— <br />I am providing food that is NOT prepared at home: [^Yes EZJ No ✓ <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: <67/^ Ogk/G^fCA < Phone: ( ‘tiffin 7_jL-------------- <br />Address of facility-? __________________________________7----------------------:----- <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 />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 />Note: The only operations not required to provide enclosed booths are <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 />[^On-site hose bib that is connected to a potable water source. <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 prioytyttfi^evjnt. )] <br />ISLAAJ05 C-^rr] Date(s). 4/27- <br />The following is information about my organization/business: <br />(fyo ?*/&<!>6 <br /> Other (specify):--------------------------—--------------------------------------------------- <br />Electricity is provided for my booth’s use: O Yes [?] No , , <br />I am providing an accurate probe thermometa^to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: IZ1 Yes 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 <br /> Double steamer <br /> Electric stove top