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S A N J O A Q U I N Environmental Health Department <br /> C 0 t_J N1 T Y— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit)are required to retum a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event.1. 1.Name of Event: C. [�'Date(s): l"� k L <br /> 2. The following is information about my organ izationlbusiness: l <br /> Name of organ izationlbusiiness:_ Drea's Kitchen v <br /> Address: S R� <br /> Phone. ( ) �-i - (^ Alternate:( ) <br /> 3. List food to be sold or given to the public:ErVL'1' ]�& \ ,�X 6Q .alkte1: �nQd <br /> 4. I am providing food that is NOT prepared at flame:❑Yes tun �` <br /> All food is prepared on-site or is fr m a roved commercial facilities:[I Yes M No <br /> Name of facility: Phone:f 1 <br /> Address of facility: <br /> 5 1 am providing a booth with the following; (to protect my unpackaged food and food-preparation 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 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 /> Other(specify):1 M- _j <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages NM <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 /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable w ter source. <br /> Other(specify): <br /> 7. E <br /> lectricity is provided for my booth's use-❑ es❑No <br /> 8_ 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Yes❑No <br /> 9, 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑camp stave ❑Stemo&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top V61-her(specify) <br /> Note- Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs.,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton,California 95205 J T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 1E-07 Page 7 or 11 TEMP EVENT APP <br /> MY17 <br />