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SAN JOAQUIN <br /> Environmental Health Department <br /> o <br /> /2 ram. 2 <br /> t <br /> C ` COUNTY— <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 /> nn II Q <br /> 1. 1.Name of Event: _/U >�- Date(s)- � <br /> 2 The following is information ai)out my organization/business <br /> Name of organ izationlbusiness: <br /> Address: <br /> C r�Sl_,tl <br /> Phone: ( ) �/J ! Alternate: (�j U E <br /> _ 3. List food to be sold or given to the public: �� <br /> 4. 1 am providing food that is NOT prepared at home: L f Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: [ 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 /> A booth with walls and ceiling constructed of either wood. canvas. plastic, similar ma►-anal and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have a sn tooth 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. Approvec water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Er-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 all potentially hazardous foods above <br /> 135°F. <br /> ❑ Camp stove ❑ Sterno & riotel trays <br /> ❑ Double steamer ❑ Steam table & lids <br /> ❑ Electric stove top <br /> Other(specify) '6�Q rr%"—f / <br /> Note: Examples of potentially hazardous f odinclude: <br /> meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dal products. <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 4 www.sjgov.org/ehd <br /> ^ TEMP EVENT APP <br />