Laserfiche WebLink
SAN JOAOUIN I iivironniontal I I(jal1h D(j|>;u tinent <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of I vent1 <br />2 <br />I’hone <br />l ist food to be sold or given to the public3 <br />4 <br />5 <br />6 Approved waler for drinking, utensil and hand washing will be provided in my booth by the following methods <br />8 <br />9 <br />I.I ll.i/du.u Avofiui* | Stockton California 9S205 | I 209'168 3-120 <br />HOW Page/o'I’ <br />QG/19/19 <br />Noto: The only operations not required Io provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />I 209 464 0133 1 www s/gov oig 'ehd <br />II MP f VI Nr API* <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 tliree (3) weeks prior to this event <br />.-L- __■ <br />y'') <br /> Alternate: ( C ) <br />The following is information about my organization/business <br />Name of organization/business r4^2) /i/zZ/X <br />Address //jV <br />I am providing food (hat is NOT prepared at home M Yes ( | No <br />All food is prepared on-site orjj> from approved commercial facilities: (Jkf Yes ( I No <br />Name of facility: Phono: ( ) <br />Address of facility:._________________________________________________________________________ <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 />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 cleanablc 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 />(TOther (specify):.... /■ <br />Noto: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: M /}. <br />[ | Stercfo & hotel trays <br />[ J Steam table & lids <br />( ) Ollier (specify) <br />meats, tamales, cooked beans, rice, <br />I | Approved bottled water <br />M On-site hose bib that is connected to a potable water source <br />F ] Other (specify) . /f' \ <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: I^ Yes ( I No <br />I I Camp stove <br />I ] Double steamer <br />I 11 lectric stove top