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SAN JOA UIN Environmental H alth Department <br /> COUNTY <br /> y. <br /> Gr Qlr�S4 r �'."rC 6cr,'. <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: FbJV Af K,41-HINI Date(s): Albl,[ l- 2 ZD 2 t <br /> T <br /> 2. The following is information about my organization/business: <br /> Name of organization/business:292WfiK c4nfoA 0 AE S Will- <br /> Address: -3.1.5— 'PiCA)M0__Il E D , CA- 2: 2-41 <br /> Phone: (Z(q ) <J D ' `.� �f ,�-,. AlternaC�te: (Y/,q) <br /> 3. fist food to be sold or given to the public: c� J <br /> 4. 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-i5fte or is from approved commercial facilities: L ',Yes ❑ No <br /> Name of facility: Phone: 0d <br /> Address of facility: f� <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 /> 01A 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 /> [`Approved bottled water. <br /> 210n-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 all potentially hazardous foods above <br /> 135°F: <br /> EkGamp stove ❑ Sterno& hotel trays <br /> ❑ Double steamer ❑Steam cable& lids <br /> �� i - / 0 <br /> ❑ Electric stove top Other(specify) (/ �t,�/ Z <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1868 E. Hazefton Avenue J Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 1"2 Page 7 of 11 TEMP EVENT APP <br /> 0710 112025 <br />