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S AN jDAQUIN Fnveircnynentai Flealth Departmelrit <br /> _COUNTY-- <br /> ." (�iCc'dt'l185[ Jrc�:S il�i'c• <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> ed and completed copy at this chock <br /> All food vendors (both for profit and on-par iitt)this required to return a signl t to <br /> the festival coordinator three(3)weeks p y� Date(s) <br /> : v' 1 ZU <br /> 1. 1.Name of Event: <br /> 2. The following is information about +L <br /> �o ga^izattlonlbu�lss: 1_` <br /> Name at organization/business !rl: W'M� <br /> Address: <br /> *— O (� Alternate:( ) <br /> Phone: (�J ) <br /> 3. List <br /> food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: Yes qy No Yes 0 No <br /> All food is prepared on-site or is from approved commercial facilities:❑ <br /> Phone: <br /> N.—of facility: <br /> Address of facility: protect my unpackaged food and food-preparation areas tram mew, <br /> 5. 1 am providing a booth with the following:(to p <br /> dust and the public) <br /> A booth with walls and ceiling constructed <br /> a of either <br /> s. It will ood, cahave al smooth a similar material and fine mesh nd cleanable floor (concrete, <br /> y <br /> screening, completely enclosing p <br /> able) and constructed to separate food and food preparation <br /> asphalt, clean tarps and smooth wood are accept <br /> areas from the Public- <br /> *other(specify):Note: The only operations not regac�� to farads Qom approved <br /> ed sources. those which sell beverages from <br /> approved dispensers,or prepackaged <br /> 5 g. Approved water far drinking,.utensil and hand washing wilt be provided in my booth by the following methods: <br /> Approved bottled water. <br /> On-site hose bib that is connectedto a potable water source. <br /> Other(specify): ' ` Yes No <br /> 7. Electricity is provided for my booth's use:❑ <br /> S. lam providing an accurate probe thermometer to measure the <br /> hot and cold holding of potentially hazardous —� <br /> all times a booth operation:❑Yes❑NO _. <br /> foods during lint temperature car trol for the hot holding of all potentially;iazardous foods above <br /> g. -I am providing the fo{lowing <br /> 135°F: �]Sterno&hotel trays <br /> n Camp stove <br /> Double steamer ❑Steam table&lids <br /> Other(specify) <br /> Electric stove top food <br /> ❑ <br /> Note: Examples of potentiallyaalleggsardous dairy products. <br /> e meats, tamales, cooked beans, rice, <br /> vegetables,potato s <br /> ray F <br /> _ TE.dp EVENT APP <br /> 1868 E. Hazelton Avenue� Stockton, California 9520591 7 f209 468-34201 t= 209 4$4-01381 www.ssce .cam <br /> 11 <br /> EHD 15-02 <br /> a7rzil7 <br />