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vle'5 <br /> � - S A N siJ O A Q U I N Environmental Health Department <br /> t� <br /> t._.r - COUNTV— <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: ' C�/�1��1Dl�i,?1 � - G<J �Cf��. _Date(s}: •�- � ��`�� <br /> 2. The following is information about my organ izationlbusiness: <br /> Name of organ izationlbusiness: <br /> Address: �I �-S /9 L A S� <br /> Alternate: (�� ) <br /> Phone: (�fX' ) a y� <br /> F VIG� Q�� rf 1Q C" ��U <br /> 3. List food to be sold or given to the public: v <br /> 4. 1 am providing food that as NOT prepared at hame:'5�Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities ❑ Yes ❑ No <br /> Phone: <br /> Name of facility: <br /> Address of facility: <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br /> dust and the public) <br /> structed of either wood, canvas. plastic, similar material and fine mesh fly <br /> WA booth with walls and ceiling con <br /> screening, completely e smooth wood aoedacceptable) and constructed to sepa ate food andl also have a smooth and cleanable dfood preparation <br /> asphalt, clean tarps and <br /> areas from the public. <br /> ❑ Other(specify): <br /> Note: The only operations not required <br /> to food de enclosed d booths <br /> ssourcare those which sell beverages from <br /> approved dispensers, or prepackaged <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> �pproved 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,thermorneter 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°1': <br /> ❑ <br /> [I Camp stove Stemo & hotel trays <br /> lids <br /> ❑ Double Steamer ❑ Steam table 8� <br /> ❑ Electric stove top Other (specify} �13 G •� �'�Y� <br /> Note: Examples of potentially hazardous food meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, a dairy <br /> 1 RRR F Ha7eltt�n Avenue i Stockton. Califomia 95205 l T 209 468-3420 } F 209 464-0138 1 www.sjgov.orglehd <br /> TEMP EVENT APp <br />