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SAN JUAOUIN Environmental Health Department <br /> [C7lINITY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-prorit)are required to return a signed and completed copy of this cher-Wist to <br /> the festival coordinator three(3)weeks prior I this event. <br /> 1. 1.Name of Event: !- Cf W'r , ) f fi t ✓' 't Date(s). <br /> 2. The following is information about my crganizationlbusiness: <br /> Name of organizalionlbusiness: <br /> Address: <br /> Phone: {Z� / �!� ! yj Alternate:{ ) 7 <br /> 3. last food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:R]Yes❑No <br /> All food is prepared ors-site or is from approved commercial facilities:(D Yes❑No <br /> Name of facility:SU.--27 14 '✓ -.. ;-''.f- Phone: <br /> ` yS <br /> Address of facility: fJ 4+•t7 f-/ 'q r G ✓r f 6,;6 <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas fl om 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 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 precaration <br /> areas from the public, <br /> H Other(specify): C.r <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 /> 6. Approved crater 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 <br /> is connected to a potable crater source. <br /> a <br /> Other(specify):_!O-k 6jt fs'6e7`--!- fir:r <br /> 7. Electricity is provided for my booth's use: Yes❑No <br /> 8. t am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:Q Yes❑No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑Double steamer Q Steam table&lids <br /> ❑Electric stove top ®Other(specify) I4 u+ <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked bears, rice, <br /> vegetables,potato salad,eggs,and dairy products, <br /> 1868 E.Hazelton Avenue J Stockton,California 952051 T 209 468-3420 1 F 209 464-0138 1 mv%v.sjcehd_com <br /> EHO 15.02 Pogo 7 d 11 TEUP EVENT APP <br /> 07/3W <br />