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SAN JOAQUIN I nvii oi iih<?i k'. iI I lea U h Depart meiu <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 <br />2 <br />Address <br />).Phone ()_ <br />3 <br />4 <br />!> <br />[ | Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods6 <br />( ] Approved bottled water <br />[ | On-site hose bib (hat is connected to a potable water source <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 />I I Sterno & hotel trays <br />I | Steam table & lids <br />I | Other (specify) <br />7 <br />H <br />AW.V S/]')-, fl.; i'I’U <br />' I I VI N' Apr <br />I | 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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />I zu'" .|< 4 (i • <br />_____ Alternate ( <br />l ist food to be sold or given to the public <br />I am providing food that is NOT prepared al homo. ( | Yesj/j No <br />All food is prepared on-site onsjrom appi <br />Name of facility vp / <br />Address of facility:.^. HtCLChlJ-lS - -X-' <br />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 />ipproved commercial facilities./| Yes ( | No <br />____Phone: <br />, C/1 ..-...... <br />h'v.vJ Ha/elloii Avt'iiih’| Stockton C.ililomi.i UMiOf* ! I '.'"9 4(::> .-I/O <br />I HO IG O? Page 7 of 11 <br />0/.'OU?0?<1 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist Io <br />the festival coordinator throe (3) weeks prior to thisevent </ , / <br />1 Name of l-Jvont Date(s) 5 <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />[ | Other (specify): <br />Electricity is provided for my booth's use [ I Yes I. ] 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 I | Yes I | No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T. <br />I Camp stove <br />I Double steamer <br />1 I Electric stove top <br />I he following is information about my organization/busmess <br />Name of organization/busmess