Laserfiche WebLink
TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) aro required to return P signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event <br /> 1. 1.NameoiEvent ��b(; C',`M iC W _ _ Date(s):_ <br /> 2. The following is infomiation about my organizationlbusiness: <br /> Name of organization/business: L) c t�!Ij-S I ,l-ra%' i[< e_ <br /> Address' 3 .'>Cl� . V ZI -el I 12<h ch � i� (3. <br /> Phone- { qtt: ) s , - ou TW Alternate: ( )� <br /> 3. List food to be sold or given to the public: '�'� L'I j�=�� t7�LC 7 i T E,' ` +f: '�ii c� f'�t T-0 r.s <br /> 4 1 am providing food that is NOT prepared at home: ® Yes ❑No <br /> /lit food is prepared on-site or is from approved commorcial facilities: Yes❑ No <br /> Name of facility: V,, e '.Sk, 5 Z-_' ;-I) Phone: l�t — <br /> AddressCA L;j't'e`i C-14 U'—4_ <br /> I 5. 1 am providing a booth with the following: (Lo protect my un ackaged forA and food-preparation areas from flies, <br /> l dust and the public) VACC.iti'11r,'•'� <br /> ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, complctely enclosing open food areas. It will also have a smnoth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas frorn the public. <br /> a I <br /> [ Other(specify): FEE <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 sourcos. <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 /> [IP 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[] Na <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: N Yes❑ No <br /> 9. 1 am providing the following hot temperature conlrol for the hot holding of aA potentially hazardous foods above <br /> 135-F: <br /> El camp stove ❑Sterna& hotel trays <br /> N Double steamer Steam table&lids <br /> F] Electric stove top Q Other(specify) Foss.Note: Examples Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> 1868 E. Kazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0133 I wv w.sj9ov.ergfAV rlehdp� <br /> CND 16-02 Par 7 cf 11 <br />