Laserfiche WebLink
S A N 10A Q U I N LRV�FOMGMW Heafth Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)ara required io return a signed and completes copy of is checklist to <br /> the festival coordinator three(a)weeks print to t,nua.,t j <br /> 1. 1-19ameofEvent: 41 •��� /S S/N�J`2L�3_ <br /> 2. The following is informaton about my organization/business; <br /> Name of organizationlbusiness: <br /> zl`1 <br /> Address: <br /> �6 )���— � le- <br /> Phone. <br /> 9 Alternate: ( ) <br /> 3- Ust fond to 16e sold or given to the public: <br /> 4E 1 am providing food that is NOT prepared at home: 1'es[]No �o ' uJ�F�� � ��`� <br /> Alf food is prepared on-site or is from approved commercial facilities: <br /> Name of facili l- LI/ L!- Res❑ [tlo <br /> kCD r1 �/ rerr l'h4rie: fJrJ`�j Z <br /> Address of facility; r k �� �JL'�br o � �6 <br /> 5. 1 aril providing a booth with th following:(tn protect my unpaekaged food and food-preparation areas from flies <br /> dust and the public) <br /> 1Y,A booth with walls and ceiling constructed of either wood, canvas, plastic,similar <br /> material and fine mash fl <br /> screening, completely enclosing open food areas. It will also have a sm oth 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 /> Mote: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged fcods from approved sources. <br /> e. Approved water for drinking, utensil and hand washing MI be provided in my booth by the following methods: <br /> �� <br /> l�pproved bottled water- <br /> El On-site hose bib that is connected to a potable water source. <br /> ❑ Dther(specify): <br /> 7. Electricity is provided for my booth's use: , Yes El-No <br /> 8. 1 am providing an accurate prone thermomete measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes❑ No <br /> 9. 1 aril providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> Woub <br /> � p stove temp&hotel trays <br /> le steamer <br /> ❑Steam table&lids <br /> ❑Electric stave top ❑Other(specify) <br /> Note: Examples of pfltentially hazardous food lincludn- mPaL5, famnles, conked beans', rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E_ Hazelton AvC-MIA j Stockton, California 95205 i T 209 462-3420 1 V 209 464-4138 1 www.sjgov.org/ehd <br /> EHD 16-02 <br /> fl6H o�19 Pace 7 o°11 TEMP'EVENT APP <br />