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-F�, �0 1,6 <br /> S A N ) OAQUIN Environmental Health Department <br /> .T. <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. �a� <br /> 1. 1.Name of Event: �/T/L Date(s): �- <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: .%�/9 <br /> Address: iL-3 <br /> Phone: 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: ] Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes ❑ No <br /> Name of faciiity: Phone.- <br /> Address of facility: - <br /> 5. 1 am providing a booth with the following: (to protect my urpackaged 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 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 /> 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 ❑ Sterna & hotel trays <br /> ❑ Double steamer Steam 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. California 952051 T 209 468-3420 1 F 209 464-0138 j www.sjgov.org/ehd <br /> ENp 16-02 Page 7 of 11 TEM9 EVENT APP <br /> na,aonn0a <br />