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SAN JOAQUIN Environmental Health Department <br /> C (_)I_! t,J T Y - <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. l <br /> 1. 1.Name of Event: A 1 j LQ ) R C Date(s): 6II LI Zc'-5 <br /> 2. The following is information about <br /> tmmy,,o-rgani]z�ation/busii}n�ess! c f b <br /> Name of organizationlbusinessf/i L_C E1l li j <br /> Address: %"I ~l(�1'djY! ? ! 'L �i� ((y��]c dl L lq— r� <br /> 11,,`` I <br /> Phone: ( ��) U, (7 C',Z c( { 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:0 Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: �j Yes ❑ No / <br /> Name of facility: T �� <br /> r l : � Phone: "2 - ���(l <br /> Address of facility:C j u fj� L1-L 1 <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 /> sre <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> ening, 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: 1)/(}- <br /> ❑ Camp stove ❑ Sterno &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 F. Hazolton Avenue I Stockton. California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> OV0112024 <br />