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Environmental Health Department <br />1.I.Name of Event: <br />2. <br />Address: <br />Phone; <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <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 />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />J^Approved bottled water. <br />O On-site hose bib that is connected to a potable water source. <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />r <br />"i <br />SANJOAQUIN <br />------COUNTY------ <br />Grea ln<?5,s growi here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify): _________________________________________ <br />Electricity is provided for my booth's use: Yes^ No <br />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: Si Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids / <br />T^GOther (specify) /Mf <br />Note: Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products. <br />. _ ______________ mense°N° <br />ess of facility: f 02^ <br />providing a booth with the following:^o protect my unpackaged food and food-preparation areas from flies, <br />The following is information about my organization/business: <br />Name of organization/business: <br /> Alternate: ( ) <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at home:^Yes No <br />All food is prepared on-site or i&frpm approved commeraal facilities: <br />Name of facility: <br />Address of facility:. <br />I am | <br />dust and the public) <br />/zS-A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />7 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 />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklistto <br />the festival coordinator three (3) weeks prior to this event. <br />4^^._______Date(s);