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SA N 1 U AQ U I N Environmental Health Department <br /> —.._COUNTY--- <br /> ' <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 prior to this event. _ <br /> 1_ 1.Name of Event: L L_( : �1 O F[i!f c Date(s):_+2. The following is information about my organization/business: 7V5 <br /> Name of organizationibusiness: ! f t ` '! t <br /> Address: mil' 1'1 �, L z 1^ q BU <br /> Phone: (x.C,ti� Alternate:{/s�� ) 751�l <br /> 3. List food to be sold or given to the public: Ff A s r o S <br /> 4. l am providing food that is NOT prepared at home:21 Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:El Yes�]No <br /> Name of facility: Phone: <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 /> dust and the public) <br /> M 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 following methods: <br /> fA Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use:©Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:Pn Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135T.- <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑ Electric stove top jZothef(specify) G '� <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E.Hazelton Avenue E Stockton, Galifomia 952051 T 209 468-3420 1 F 209 46"138 J www.sjcehd.com <br /> EHD 16.02 Page 7 of 11 TEMP EVENT APP <br /> 911W17 <br />