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I <br /> l SAN JOAQUIN Environmental Health Department <br /> 1 <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 th+s checklist to <br /> the festival coordinator three(3)weeks prior to this event <br /> 1 1 Name of Event I f k i S+ it ! �ld G Pi,#Af'''&te(s) 07— o y--2,&L5 <br /> 2 The following is information about my organization/business <br /> Name of organization/business: 'oo_j 5 lit t>' >P1 G�5 <br /> Address 2.. <br /> Phone (ZOq ) O Alternate: ( 7.01) 9 <br /> 3 List food to be sold or given to the public: f}er kcn . t'laun l r; 4 torc► fr►; h �""yv <br /> S-KMO54i (kore) l4a+.4re-,. Wwrt; <br /> 4 1 am providing food that is NOT prepared at home: KYes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ®Yes❑ No <br /> Name of facility: 400 li rxiii a QP 0 hone: (2(M } 5 31-14 1100 <br /> Address of facility: 2 GUy i�ChQ II �-OA.A &l+e #12_ <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 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 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 sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6 Approved water for drinking, utensil and hand washing wilt be provided in my booth by the following methods <br /> Approved bottled water, <br /> ❑On-site hose bib that 1s connected to a potable water source. <br /> ❑Other(specify). <br /> 7 Electricity is provided for my booth's use: ❑ Yes X No <br /> 8 1 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 /> 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 /> Fj 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 I Stockton. California 95205 1 T 209 468-3420 1 f 209 4C54-0138 I ww w slgov org ehd <br /> F140 16.02 f'apo 7 of 11 ►BAP INFNT APR I <br /> 0710 WON � <br />