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SAN�JOAQUfN Environmental Health Department <br /> L-1 Coin - -- <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 checklists to <br /> the festival coordinator three (31 weeks prior to this event. <br /> �I ) a <br /> 1. 1.Name of Event: eARL �I /UT C`7�- Date(s): �- <br /> 2. The f0owing is information about myorganizationlb4u�silness - f <br /> Name of organization/business: <br /> Address. <br /> Phone: ( ) `J Alternate: (. � ) U " p <br /> IList food to be sold or given to the public: <br /> $ttGy-, IaC ,s, ,Jai}� r��zar�i,l5 <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 facility: Phone'. <br /> Address of facility: <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ECA 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. Approv water for drinking, utensll 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;, Yes No <br /> 7. Electricity is provided for my booth's use: ❑ <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 Cl 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 /> ❑ m <br /> ❑ Camp stove Steo & hotel trays <br /> ❑ Double steamer ❑ Steam table 8 lids <br /> ❑ Electric stove top <br /> Other(specify} <br /> Note: Examples of potentially hazardous <br /> dairy pdro include. <br /> meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, egg <br /> ov.or Iehd <br /> TEMP EVENT APP <br /> 1868 E. Hazelton Avenue I Stockton California 952051 7 209 468-3420 1 F 209 464-0138 1 www.sjgov.org <br />