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S A N 10 A Q U I N 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 /> 1. 1.Name ofEvent: 712` 14g /K/09 /.eif _. Date(s): 7/y/11, <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: f�/mod. aS e-dylsS514PWs <br /> Address: 9, ��ihrnlJ,c�if- /mac - Clo✓,% <br /> Phone: ( �ham) 3 9"7 - "S Ji' Alternate: ( 531) <br /> 3. List food to be sold or given to the public: P' 'l.� 4- Mex_ <br /> 4. 1 am providing food that is NOT prepared at home: [des ❑ No <br /> All food is.prepared on-si)or is from approved commercial facilities:4E�J"Yes❑ No <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 /> ❑ A booth w4h 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 /> ar6tther(specify): 4fXk•I,s« _ L-7--C - - <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ©proved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: es ❑ No <br /> B. 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: JJ-Y—es ❑ No <br /> 9. 1 am providing the following hot temperature control for the hat 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) N/,1- <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 I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-013B I www.sjgov.orglehd <br /> EHD 16-02 Page 7 or 11 TfMP EVENT APP <br /> 07/01/2024 <br />