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Fvo <br /> -4� SANsJOAQU I N <br /> �. Environmental Health Department <br /> tom` —COUNTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are requ ed to return a signed and completed copy of this checklist <br /> the festival coordinator three (3) weeks prior to this ev1ent.n <br /> 1. 1.Name of Event: _-< L hJ 1� T '�J Oates) �- .r/7 <br /> 2 The following is information about my organizatior/business. <br /> Name of organization/business. JJ <br /> Address ��J? � �S ,�tt <br /> Phone: (� ) <br /> Alternate: ( ? U r2 E <br /> 3. List food to be sold or given to the public: <br /> 4 I am providing food that is NOT prepared at norne Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities ; ; 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 /> I A booth with walls and ceiling constructed of either wood canvas, plastic, similar material and fine mesh fly <br /> l also have a smooth and <br /> floor (concrete, <br /> screening, completely Carpel ndnsmooth Wood aoredacceptable) alnd constructed to separate food andfood preparation <br /> asphalt, clean tarps a <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 hard mashing will be provided it my booth by the following methcds. <br /> Approved bottled water <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specifya' <br /> 7. Electricity is provided for my booth's use:! Yes ❑ No <br /> ate probe,therrnorneter to measure the hot and cold holding of potentially hazardous <br /> 8. I am providing an accur <br /> foods during all times of booth operation: Yes ❑ No <br /> g. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1 Camp stove ❑ Stemo & notel trays <br /> ❑ Cam <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top Other (specify) CAI/. <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, a al rYproducts, <br /> A„n. ja I gtnrktnn. California 55205 ! T 2� `h' <br /> 9 468-3420 I E 209 464-0138 ! ww •s19oAP EVENT APF <br />