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S A N J O AO U I N 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 L ao� � C OA-) Qate(sp ` l <br /> 2 The following is information about my organ lzationlbusiness <br /> Name of organization/business l"'t <br /> Address: <br /> Phone r, Alternate, ( ) <br /> - ( f j ? <br /> 3 List food to be sold or given to the public: \J <br /> 4 1 am providing food that is NOT prepared at home: 511yes❑No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes�No <br /> Name of facility: Phone ( l <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 /> ff?�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 /> asph0, 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 w111 be provided in my booth by the following methods <br /> []Approved bottled water <br /> On-site hose bib that fs connected to a potable water source <br /> ❑ other(specify): <br /> 7 Electricity is provided for my booth's use Yes❑ No <br /> a I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation J2 Yes ❑ No <br /> 9 4 am providing the following hot temperature control for the hot holding of ail potentially hazardous foods above. <br /> 135"F <br /> 0 Camp stove ❑ Slerno& hotel trays <br /> E]Double steamer ❑ Steam table& lids <br /> ❑Electric stove top ❑ otlrer(specify) <br /> Note: Exampies of potentially hazardous food include: meats, tamales, cooked beans, Tice, <br /> vegetables,potato salad,oggs,and dairy products: <br /> r,tj. ..i 1f1u1i°�:'CN1'AS'ti' <br />