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S A N J O A Q U I N F-MltrrOnmenb� Fleafth Department <br /> - CCtI!•.I l v <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 i/weeks prior to this event <br /> 1. t.Name of i C C-'T �C�- Date(s'' 54 f!b <br /> 2. The following is information about my organization/business; 1 <br /> Name of organizationlbusiness: <br /> Address: a,. - <br /> Phone: ( `ram)_54 -Lf Z'L <br /> 3. List food to be sold or given to the public; c•,;�L t l ' r r tr fj / C � r�,• �•7 �r"r a -/i-r" <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes L-"Ko <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes F!'�o <br /> Name of fatiility: _ Phone:f _ <br /> Address of facility:_-. <br /> 5. 1 am providing a booth'with the following:(to protect my unpackaged food and food-preparafon areas from flies. <br /> dust and the public) <br /> ❑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 vrN also have a smooth and cleanable floor (concrete, <br /> asphalt, clears tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the oublic. <br /> tither <br /> Nate: 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 /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> [I Approved bottled water. <br /> I 1 On-site hose bib that is connected to a potable vratcr source. <br /> w <br /> ❑Other{specify}:_ � i, ti � � u r�a.J-y _ _f�.y.y 1 �^P=• .b /��./��./���,,a iS <br /> 7. Electricity is provided for my booth's use:E]Yes No <br /> m J ti /� <br /> 8. 1 a providing an accurate probe thermormeter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Yes El No ti/.4 <br /> 9, 1 am providing tha fallowing het temperature cpntrof for the hot holding of all potentially hazardous foods above <br /> 135°F., <br /> C Camp stove ❑Sterno&hotel trays <br /> [, Double steamer 0 Steam table&lids <br /> Electric stove top ❑Other,specify) <br /> Note-. Examples of potentially hazardous food include; meals, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E.l-lazelton Avenue I Stockton,CaVornia 95205� T 209 468-3420 1 F 209 464-0138 1 vrww.sjcehd.com <br /> ENn%fi"12 Pap 7 of 11 T['Si'�VrNI A�'1' <br /> 07i3:17 <br />