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SAN MOWN <br /> Environmental Health Department <br /> 'l ---COU NTY <br /> Gr-eatness gro::s here. <br /> `p• '0PORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for pro€a and non-prom)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event <br /> sO <br /> 1. 1.NameofEven� i u��� cift �� ❑ate(s): <br /> 2. The following is infomzatlon about myorganizationibusiness: <br /> Name of organiz—tionlbusinee�s�s:,,`' lamb V���1[1�,71� <br /> 29 <br /> Address: — `� �}'l Y.h\�Q v v"`N ►V v �1"J t� <br /> 'Phone: C(%o_ } LY Alternate:( ) <br /> 3. List food to be sold or given to the public: Vl Q C�� lf'S <br /> 4. t am providing toad that is NOT prepared at home:[I Yes _No <br /> Alt food is prepared on-site or is from approved commercial facilities: ❑Yes,nNo <br /> Name of facility: Phone:f ) <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 /> treA booth with wafts and ceiling constructed of eitherwood,canvas, plastic,similar material and fine mesh ly <br /> ening, 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): <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 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 /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use:❑Yes No <br /> S. l am providing an accurate pane thermometer to measure the hot and cold holding of potentia%r hazardous <br /> foods during all times of booth operation:❑Yes❑No <br /> 9. 1 am providing the following hotfemperature control for the hot holding of all potentially hazardous foods above <br /> 135°p: <br /> 0 camp stove ❑Sterno&hotel trays <br /> 0 rouble steamer ❑Stearn table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Nate: Examples of potentially hazardous food include: meats, tamales, cooked towns, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E Hazelton Avenue I Stockton,California 95205 j T 209 468-34201 F 209 464-0138 1 www.sjcehd.com <br /> EHD 1"2 Page 7 of 11 TEMP EVENT APP <br /> M397 <br />