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S <br /> S <br /> 1 <br /> SANJQAQUIN <br /> ff Environmental Health Department <br /> .—CUl1NTY-- <br /> sPf Greatn, ornws lierL�. <br /> TEMPORARY FOOD VENDOR'S APPLICATION ;1 <br /> All food vendors(both for profit.nd non-profit)are required to return a signed and completed copy of this checklist to 9 <br /> tho festival ccordinatorthrce(3)wesks prior to tfiis event. <br /> f. -1.Name of FvenL' DatA(s); Ut' <br /> b <br /> 2. The following is information about my organizatianli�usiness: .r ��� <br /> Name oforgarizationlbusiness <br /> Address: <br /> Phone: {�Cf 1)_��` ��=��.�_..__ Alternate: <br /> 3. List food to be sold or given to the public: a--r <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes ZW o <br /> Ali fcec:s prepared on-site or is from approved commercial facilities:❑Yes DWIo <br /> Name cif facTty: Phone:f 1 <br /> Address.affecility: <br /> 5. 1 am providing a booth with the fallowing:(to protect my unpackaged•food and food-preparation areas from tlies, <br /> dust and the public) <br /> f4A booth with walls and coiling constructed of either vrood,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): <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 fallowing methods- <br /> ❑Approved bottled water, <br /> ❑On site hose bib that is connected to a potable water source. <br /> f]Othef(specify): <br /> 7. FlecMcity is provided for my booth's use:[]Yes�"a <br /> 8- 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentia!ty 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 /> E Camp stove ❑Sterno&hotel trays <br /> ❑Doable steamer ❑Steam table&lids <br /> ❑Electric stove top ❑ Other(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. Hazelfon Avenue J Stockton, California 95205 T 209 468-3420 l F 209 464-0138 f waaw.sjcehd.cam <br /> EHD 7&G2 a7i31f7 Page 7 cf 11 TEMP EVENT APP <br />