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SAN JOAQUIN Environmental Health Department <br /> COUNTY <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 /> Downtown Tracy Farmers Markel Saurda s Year Round <br /> 1. 1.Name of Event: y Date(s): <br /> 2 The following is information about my organizationlbusiness: <br /> Name of organization/business: <br /> Address: 2Y <br /> Phone: (909}` r Alternate: <br /> 3, List food to be sold or given to the public; <br /> 4. 1 am providing food that is NOT prepared at home: Yes U No U <br /> All food is prepared on-site or is from approved commercial facilities:®Yes❑ No <br /> Name of facility: Z/rrLF_ A�'L_All 7'Cl-1,,�A71 lI[ Phone: / — 3 yC0 <br /> Address of facility:_ LDI M4, <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged f4adand fnnd-pre amation areas from files, <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 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:❑Yes m 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:0 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 /> Vj Camp stove ❑Stemo 8,hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑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 F 209 464-0138 www.sIgov.orglehd <br /> EH6 16-02 Page 7 of I 1 TEMP EVENT APP <br /> 009119 <br /> • CD <br />