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SAN JOAQUIN I ;nvii ()nni<?nL'il I leaIIh Heparinici»i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Datc(s) <br />2. <br />Address. <br />Phone <br />3. <br />4 <br />5 <br />( I Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in niy booth by the following methods <br />[ | Approved bottled water <br />9 <br />meats, tamales, cooked beans, rice, <br />Note: The only operations not required to provide enclosed booths are (hose which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />I | Sterno & hotel trays <br />( | Steam table & lids <br />( | Other (specify) <br />7 <br />8 <br />A.‘.'.7 S.ipiv (»•.; I'I'U <br />II MP I VI N' APP <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. Il will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />[ | On-site hose bib that is connected to a potable water source. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at homo: Yes | J No <br />All food is prepared on-site or is from approved commercial facilities: | I Yes ( | No <br />Name of facility: .. Phone: ( ) <br />Address of facility:___ <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />[ I 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: [ | Yes ( ] No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />[ | Camp stove <br />[ | Double steamer <br />• | Electric stove top <br />(^^). y1-/) <br />l.ist food to l)e sold or given to the public: tS’Z- » o <br />Name of orgamzalion/business <br />f • <br />1 I I ta/<;!|un Avoime 1 Stockton C.ililnniia ; l ?()9'K>S TITO ' I ZO'i-W.Z ' ! <br />(HO IGO? Page/of’I <br />O//0VZ024 <br />The following is information about my organization/business: <br />( t <br />Alternate ( <br />C>rC 5 <br />Z / C\ 4 <br />z ^£>2 > <br />) <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. Name of Event-I 1