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SANJOAQUIN Environmental Health Department <br /> C (DUN <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 checklists to <br /> the festival coordinator three (3) weeks priory to this event. <br /> 1. 1.Name of Event: /� L' .'/ �✓ J I'�'i � �7 Date(s):JL!, 56 <br /> 2. The following is information about my organ izationlbusiness: <br /> Name of organ izationJbusiness: <br /> 1 /t 1 L51 E_t % <br /> Address CY <br /> Phone: Alterna'te: <br /> 3. List food to be sold or given to the public: 4Tcj 1 <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;Kyes ❑ 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 /> �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 self 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 /> ❑ Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other (specify): [] No <br /> 7. Electricity is provided for my booth's use: j <br /> 8. I am providing an accurate probe then te measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operations ❑ No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top _i ther(specify) 17r j`1 <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 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> EHO 16•02 Page 7 of 1 I TEMP EVENT APR <br />