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S A N J O A Q U I N Environmental Health Department <br /> c 0u l`i- . <br /> TEMPORARY FOOD VENDOR'S APPLICATION J�3C)� <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)weeks prior to this event. <br /> 1. 1.Name of Event:�e�� � r: J �� _ Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: Z1Zt1 ,L_ZLZ1e­,4­, <br /> / ' <br /> Address: !r y '7 % r L7!�/�,t-J - r s��..� �� �� ?d 5 <br /> Phone: ( Rq, } 519 / 7�� Alternate: ( 7' � <br /> 3. List food to be sold or given to the public: 20 44r <br /> 4. 1 am providing food that is NOT prepared at homer Yes ❑ No <br /> All food is prepared on-site or is from approv d commercial facilities Yes ❑ No _ <br /> Name of facility: S - �;p_' _ Phone:/L� <br /> Address of facility: /e�J/,6 /,4.7 <br /> 5. 1 am providing a booth with the following: (to pro ect 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 /> JurOther(specify): /e k I o Q , <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: ❑Yesg No <br /> 8. 1 am providing an accurate probe thermometer to me sure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: [_1Yes o <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 stove ❑ Sterno &hotel trays <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top L�-dther(specify) P,- e �,c c/����/ JA <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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENTAPP <br /> 07/0112024 <br />