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r <br /> SAN JOAQUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 /> ZZ1. 1.Name of Event: 1 ! Date(s): J� <br /> 2. The following is information about m org nizationlbusiness: <br /> Name of organization/business: Z/YY��/ �UiCY U <br /> Address: r� <br /> Phone: U— Alternate: <br /> 3. List food to be sold or given to the public /�) eY-�- <br /> 4. 1 am providing food that is NOT prepared at home: �es ❑ No '(/�'vt ��L'!! /�✓���) <br /> All food is prepared on-site or is from approved cont mercial facilities: es ❑ No w�/ �' UU7"7 <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br /> dust and the public) <br /> ,)4'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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public <br /> ❑Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which self beverages from <br /> approved dispensers, or prepackaged foods from approved sources <br /> 6. Approved water for drinking. utensil and hand washing will be provided in my booth by the following methods. <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source <br /> X Other(specify): <br /> c-5 �z,)aAv- <br /> 7. El ctncity is provided form oth's use Yes <br /> 8. 1 am providing an accurate probe thermometer to easure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operationes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ camp stove ❑ Sterno& hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs, and dairy products. <br /> 1868 E. Hazelton Avenue ; Stockton, Gahtornia 95205 1 T ZU9 468-3420 1 F 209 464-0138 1 www,sjgov.org/ehd <br /> EHD 1"2 Pope 7 of 11 TEMP EVENT APP <br /> 07r01 f2024 <br />