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F-V -'o /�Z <br /> SANd0A0UIN <br /> Environmental Health Department <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: /y 111C� YC ,�. _Date(s):AeK <br /> 2. The following is information about my organization/business: - I <br /> Name of organ izationlbusiness: .�-� 1 /`� <br /> Address: <br /> Phone: Alternate: <br /> 3. List food to be sold or given to the public: ci G �tLf-r! Nt <br /> V-', h/19u,�l�, e SUj ►2 �/ �l��Ycc S t <br /> 4. 1 am providing food that is NOT prepared at horneoYes ❑ No <br /> All food is prepared on-site or is froomlapproved commercial facilities ❑ Yes <br /> Name of facility: � �' Phone: <br /> Address of facility: '3— �U C C <br /> 5. 1 am providing a booth with the following: (to prot ct my unpackag food and ood-preparation areas from flies. <br /> dust and the public) <br /> _, H booth with walls and ceiling constructed of either wood, canvas, plastic, similar materiai 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 fdl owing methods. <br /> �pproved bottled water <br /> 'Zon-site hose bib that is connected to a potable water source. <br /> ❑ Other(specifyr. <br /> 7. Electricity is provided for my booth's use, ❑ Yes No <br /> 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operationZYes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: p <br /> ❑ Camp stave temo 8 hotel trays <br /> ❑ Double steamer tearn table & lids <br /> ❑ Electric stove top ❑ Other (specify) <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 I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> -A , TEMP EVENT Af P <br />