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SAN DAQUIN Environmental Health DepatIment; <br /> — COUNTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both far profit and non-profit)are required to return a signed and completed copy of this checkfist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1f1 � �r <br /> 1, 1.Name of Event:_ r t KYk �KK Date(s):L_ <br /> 2. The following is information about my organ'iztta annbusiness: 1 <br /> Name of organization1usi H ness: L`1 Q '�^ _J�,Jk C�'1 Q k— <br /> address; !1> 1 .1 tC S <br /> Phone: ( [} — Alternate:( } <br /> 3. Ust food to be sold or given to the pubric:0agaut ( t r' <br /> 4. I am providing fcod that is NOT prepared at home:E)Yes No y <br /> All food is prepared en-site or is from approved commercia(facil€lies:❑Yes Q No C. <br /> Name of facifrty: .Yl {' phone:f{ [L�C7 U2 C7 <br /> Address of facility:, V�. <br /> 5. 1 am providing a booth with the following:(to protect rM,4bripackaged food and food-preparation areas from Me$, <br /> dust and the pubtic) <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), <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 foflowing methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable crater source. <br /> ❑Other(specify}: <br /> 7. Electricity is provided for my booth's use:❑Yes`4 No <br /> 8. I am'proMcling an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during ail fees of booth operation:❑Yes❑No <br /> 9. f am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑Double steamer ❑Steam table&Gds <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.Ha2elton Avenue 1 Stockton.California 952051 T 209 468-34201 F 209 464-0138 1 w A:v.sjcehd.ccm <br /> Er ff}76-02 Paflo7 d 15 T04F E%fIM k P <br /> A7r]rr7 <br />