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S A N J OA Q U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit?ate required to return a signed and completed copy of this medalist to <br /> the ffmtNal coordinator three(3)weeks prior to this evenL <br /> 1. 1.Name of Event: TL CC LA sal'O- a L "i tL�6ate(s i _I - 2 7 <br /> 2 The fdk wing is inforrimbort about my organization/business. <br /> Name of orgariza6nNbrss. <br /> g ) q S.7 7 <br /> ptmoe. (1,4Yh— — -7 tot) Alternate- <br /> 1 List food to be sold or given to the public: J ► AV`e k 4 C-01 <br /> 4 1 am providing food that is NET prepared at home: Q)Yes❑No <br /> All food is prepared on-site or is from approved commensal fadlifies: ❑ Yes ❑ No <br /> Name of facady �'� — Phone:L_ ] <br /> Address of facility <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-pneparatian areas from flies, <br /> dust and the public) <br /> ❑ A booth with walls and milling co&ucfed of either wood,canvas. plastic, siniar maternal and fine mesh fly <br /> saeming. completely enclosing open food areas. It wl also have a smooth and cfeariabie floor (concrete. <br /> asptratt. dean Tarp, and smooth wood are acceptable)and oorstrutW to separate food and food preparation <br /> areas from the public. <br /> ip Dyer(specify). Y1l Ag k lU- <br /> Note: The only operatrorm not required to provide erclased booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for dnniking, utensil and hand washing wdl be provided in my booth by the following methods. <br /> ❑Approved bath water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> 5rother(specify): e ' n r So�t.r Ct <br /> 7. DeclI icity is provided for my booth's use: ❑ Yes❑No <br /> 8 1 am providing an accurate probe therrnameter to measure the hot and cold holding of potenhafly hazardous <br /> foods during all tines of booth operation: ❑ Yes❑No <br /> 9. 1 am providing the following hot temperahre control for the hot holding of all potentially haran*xm foods above <br /> 135°F: <br /> ❑Camp stave ❑Sterno b hotel trays <br /> ❑ Double steamer ❑Stearn table&lids A414 <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentialty hazardous food include: meats, tamales, cooked tbewo, race, <br /> vsgetslales,potnto wed,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 1"2 Pop T d t i YEW EVENT APP <br /> aiw r rzo24 <br />