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7 <br /> ry-- S A N oJ O A Q U I N Environmental Health Department <br /> c o U N - <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 ev/ent.�I n <br /> 1. 1.Name of Event: fT 1 ,UC� �C/7� (7ate(s): <br /> �� �- <br /> 2. The following is information about my <br /> y organization/business: • ' <br /> Name of organization business: <br /> Address <br /> Phone: ( ) .57 Alternate: <br /> 3. List food to be sold or given to the public: " <br /> 4. 1 am providing food that is NOT prepared at home. (Eyes No <br /> All food is prepared on-site or is from approved commercial facilities 0 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 /> eA 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 /> 2-;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: ❑ Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of 0 potentially hazardous foods above <br /> 135°F: <br /> ❑ camp stove ❑ Stemo &hotel trays <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top .Other(specify) y r;/' <br /> Note: Examples of potentially hazardous f od include meats, tamales, cooked beans, rice, <br /> vegetables, potato salad. eggs, and dal products. <br /> 1A68 E. Hazelton Avenue I Stockton. Califomia 95205 1 T 209 468-342C 1 F 209 464-0138 I www,$)goA o g/ehdPP <br />