Laserfiche WebLink
SAN JOAQUIN L' n v i ro nmo n ta I 11 ea I th Do pa r 11 n ent <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Namc of Event:. I <br />2. <br />D 4 \ 7 <br />Address. <br />Phono: <br />List food to be sold or given to (he public.3 <br />4 <br />5 <br />I J Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methodsG <br />[ | Approved bottled water <br />9 <br />c) <br /> Alternate. ( <br />Noto: 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 Stcrno & hotel trays <br />[.) Steam table & lids <br />[ | Other (specify) <br />www siqov oig/ehd <br />Il MP I VI N I API' <br />/ <br />8 <br />I8G8I llazullon Avenue | S.tocMon C.ilifomia <)5?()5 | T ?0<)'l(>« 34?() | I 209 4G-1 0133 <br />I HO '6-02 Page/o'P <br />06'19/19 <br />| | On-site hose bib ttiat is connected to a potable water source <br />Datc(s): <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 cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed Io separate food and food preparation <br />areas from the public. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Other (specify). ( -(r< <br />Electricity is provided for my booth’s use: ( j YcsJ/HMo <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 />I | Camp stove <br />I ) Double steamer <br />I I Electric stove top <br />meats, tamales, cooked beans, rice, <br />)- <br />pV Of ( < ' - <br />I am providing food that is NOT prepared at home: [ I YespTHo <br />AH food is prepared on-site or is from approved commercial facilities | | Yes [, | No <br />Name of facility: r) jL b ‘ ~ -A, --' --t --- - Phonc: <br />Address of facility: r A S I H' I F3 / \. C A <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 />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of tins checklist to <br />the festival coordinator three (3) weeks prior to this event <br />The following is information about my organization/business: <br />Name of organization/business ( ( <br />?< ; 2