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^` SA N J OAQ U I N Environmental Health Department <br /> 'x COUNTY - <br /> _ )q� � y 5 <br /> Greatness ,;-,,:•,�; ,hG-, <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: .�/? 111_.EAThrlrl G' J? 1HDhIV Date(s): Il/Dl,/ 1-2 ,2dZ L <br /> 2. The following is information about my organization/business: <br /> Name of organization/business.- . fiK# /�SE-q C,4MLLL?t fqU 'B(,,f_SPRI Sr WEE <br /> Address: 1L33 5 plegjeS6 4(.._E D , 5 2 60 <br /> Phone: (26q ) 3.3 Alternate: 2- <br /> 3. List food to be sold or given to the public: t S <br /> 4. 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities:&Yes ❑ No <br /> Name of facility: C P one: (2d`/) Cf AZ <br /> Address of facility: C Z� <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 /> &]-"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 /> Cf Approved bottled water. <br /> abn-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: Ef 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: { 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 /> ❑ 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. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 J F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT AP <br /> 07/01/2025 <br />