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r <br /> SA N )OAQ U I N Environmental Health Department <br /> COUNTY <br /> r, --- C.�re'ol.neSS grov:s 1 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profrt) 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 of Event: Poorba H&1 2o2s Date(s): 3r15t2o26 <br /> 2_ The following is information about my organization/business: <br /> Name of organization/business: Do P-B A _5W irf[ ] P,-P.S?A u fz A r,T <br /> Address: 3310 N f—Prcl BI VD OD 'Fe A c-,l CA rq'S3 <br /> Phone: ( 70 ) _20' — R ti 19 Alternate: ( ) <br /> 3. List food to be sold or given to the public: 9WOIA, C4seA bATu¢£, j 1-A, Lkssl_,PA leccOj q u 3 r lid <br /> 4_ 1 am providing food that is NOT prepared at home: x❑Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: D Yes ❑ No <br /> Name of facility: Do"A V4,jrirT_% 4 g-6510,,4- o"T Phone: ( 2°1i 1,o4— 74lld <br /> Address of facility: 21,l W Ti kvf r3i-v n , OD i ?ekc-t CA—a,�f? <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 /> 51 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 fraft- <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 /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: if Yes � 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: W]Yes F4 No <br /> 9. 1 am providing the following hot temperature control for the hot holding at all potentially hazardous foods above <br /> 135'F: <br /> ❑ Camp stove x❑ Sterno &hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> !Vote: 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 G T 209 468-3420 1 F 209 464-0138 1 www,sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVEIdr APP <br /> 0710112025 <br />