Laserfiche WebLink
SA N 1 DA Q U I N Environmental Health 6eparrirnep-' <br /> -- COuN- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 priorto this event. <br /> 1.Name of Event: pate(s): `F Z� <br /> 2- The following is information about my organization/business: ti � 111 <br /> � L <br /> Name of organizationlhusiness: �t�' k�tea.5 1 C t p�(S/� �� { P r t� <br /> Address l49 l.f Y [ L!!1� H y€ C�y1 CA <br /> p 1 �- CG <br /> Phone: (�r5i) 3 0 ' �FCLQ Aitemate: (SSC)) <br /> 3. List food to be sold or given to the public r a (7 I t'j <br /> 1 <br /> 4. 1 am providing food that is NOT prepared at home:❑Yel) No <br /> A11 food is prepared on-site or is from approved commercial facilities:)dyes❑No <br /> Name of facility: t}A/A Phone:f ) <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> Just and the public) <br /> ❑A boolh with walls and ceiling constructed of Either wood,canvas, plastic,similar material and tine mesh i1 <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. nn Other(specify): ! — FU t,A'l Nor aSt5:J) <br /> Note: The only operations not required to provfde enclosed booths are those which sell beverages from <br /> approved d;spensers, 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 /> 6 Other(specify): e rT _ W ArC/� <br /> 7. Electricity is provided for my booth's use: Ew Yes❑ Nc <br /> 8, l am providing an accurate probe thermomete o measure the hot and cold holding of potentially 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 /> ❑Camp stove ❑Sterna&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Elseric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetabies,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-4138 j tnrww.sjcehd.corn <br /> EHD 16-02 Page 7 of 11 Tr=MP EVENT APP <br /> Juan <br />