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■NDtMHMRn <br />SAN JOAQUIN <br />TEMPORARY FOOD VENDOR’S APPLICATIONK <br />7-/^6it/;./, e I.Namc of Event1.. Da(c(S): <br />2. <br />Address: <br />Phone- <br />3. <br />4. <br />(767) r^Z <br />5. <br />S'Other (specify): <br />Approved water for drinking, utensil and hand washing v/ill be provided in my booth by the following methods6. <br />fiTApproved bottled water. <br />9. <br />moats, tamalos, cooked beans, rice, <br />7. <br />8. <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 />135°F: <br /> Camp stove <br />0 Double steamer <br />LJ Electric stove top <br />•"'I <br />The following is information about my organization/busincss. <br />l^o , <br />fl <br />< <br />3X7 /??/Alternate ( ) <br />List food to be sold or given to the public: /£./foW/ Chtflfa/y 'J(J"'oh ) ’fa. <br />Note; Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) arc required Io return a signed and completed copy of tiiis checklist to <br />the festival coordinator three (3) weeks prior Io this event. <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 cleanablc floor (concrete, <br />asphalt, clean tarps and smoolh wood arc acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> <br />I am providing food that is NOT prepared at home: {xTYcs O No <br />All food is prepared on-site or is from approved commercial facilities: j^Ycs ( I No <br />Name of facility: /Phone: j <br />Address of facility: 1 <br />I am providing a booth with the following: (to protect my unpackagcd food and food-preparation areas from flies, <br />dust and the public) <br />1868 f Hazelton/wemm | Stockton California 95205 | I 209 4G8-3420 | I 209 464 01.5'. ■ v/wv/sjguv oigvihi <br />U10 50-W Pogo 7 on t H MP LVt NT API’ <br />07/01/7074 <br /> On-site hose bib that is connected to a potable water source. <br />@ Other (specify): 1/7'a A /<_____ ____ ___________ <br />Electricity is provided for my booth's use:-tJ Yes I I No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all limes of booth operation: Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />El Sterno & hotel trays <br />C>| Steam table & lids <br />[2,1 Other (specify) <br />Name of organization/busincss <br />'f77 / A'