Laserfiche WebLink
AN J�A UIN Er�vri�°onmelital Health Depart e"t <br /> C o U N T Y---..TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and n6n-profit)are requited to return}o signed and completed copy of this checklist to <br /> the festival cnorciinatbrthree(3)weeks pricr to th1S evont, <br /> 1. i.Name of Event: <br /> 2. T hefpilowing is information about my organiretfonlbirsiness: <br /> Nan)e of organizationibusiness; <br /> C .L�' <br /> Address: <br /> Phone ,rL t a (J L'I Altemate: <br /> 1. )� -� — <br /> 3 List rood tb b stiiti Or given to the pklhrc r3,0 <br /> 4. 1-am}providing food that is NOT prepared at hoine: Yes No, <br /> All food is prepared pnsite or is from approved carnrnercial.facilities:€]Yes❑No <br /> Name of faulity: — — Phone:�3- <br /> Addres of facW <br /> 6_ 1 am prm6ding a booth with the follm ing: (to.p-otect my fin{)ackagad food and fend preparation areas from flies, r. <br /> dust am3 the nubkic) <br /> A.k�opth with walls and coifing cans uctnd of eiTarrwood,canvas,.plastic,sirnifar'material and fine mesh fly <br /> srwrn..ez,rnp,.c6jnptetely enclosing open food areas. It Will also.ha>>t a smooth and cleanable Haar(concrete, <br /> aspl�27t, ^]ears 1�rps ar,d smooth wood am acceptable) and rcnstructad to separate food and.food pi-eparat;ian <br /> am-as fron"the public. <br /> ❑Other{apeGfyJ: <br /> Note-. The only operations not requsred to prnvic'i.'enclosed 6ocths-are those which sell beverages ftr <br /> rnpror�d dispensers,orprepac}{aged foods ifan�:=pproved sa,ircas. <br /> Approved crater for drinkirig,utensil ann 11and washing. ;ll be�ro%Aded i0 my booth by tide fcltowitig methods: <br /> ❑Appmved bottled water. <br /> on-silo hose bib that is connected to"a potable water source. ryf <br /> Eler'tricify is pravided far my k"Alti, <br /> 17m Yes❑`No a <br /> 8. E am prov ding an accurate prone.`,helrmntiioter to tnEasure the hot.and <:a'.a t'+oiding of potentially hazardous. <br /> foods during all times of�colh operation:❑Yes❑No <br /> �3. I am pmviding the fpllowing hot terrpetmuro cortrol for the hot holding of all potuatialty hazardous fv bove <br /> 0(-amrj stove ❑Sterna&hotof trays <br /> ❑Double sfeamar E]Stbam lui la&lids <br /> ElecUic stow top Q Other(seer!5I) <br /> is <br /> Note. Exan)33fes of pol.enfibily fiazardOLM taod It7Gltid6-- rne�tti, tatnates,. cOtiked be531I5, rice, <br /> vegetat�l�s,potato salad,apclg,anti dairy products_ <br /> t.: <br /> '868-E. Hazelton Avenue i Stockton,Galifornle 95206 j T 20P 46t-342Q I F 200 464-Oi38 j vn�nv.S cetid.cor€a <br /> IG; }lD�6-l2 r ii 70i 11 T4:GdP E Fr f f'p <br />