Laserfiche WebLink
SANJOAQUIN Environmental Health Department <br /> E .s —COUNTY <br /> — <br /> Greotness grows here. <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 /> 1. 1-Name of Event (e4h^ M GVQ-y...- Fir_ � ___Date(s): 0 <br /> 2. The following is information about my organizationtbusiness: <br /> Name of organization/business: 'D i a.s LQ CA <br /> Address: l 1 t S• S{-+ F-'i-��3 k� `I 3 5't <br /> Phone: (12011 2�'9 - 3 2-i 3 _- Alternate:( ) <br /> 3. List food to be sold or given to the public:�Qj-�,!fs�" Cr +ej I gg U ryL r4 note s <br /> 4. 1 am providing food that is NOT prepared at homer Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities:K Yes❑ No <br /> Name of facility: 1 21 t �-o Phone: <br /> Address of facility: t-A x `S 1 '�C.b•.ty.. L,�L <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 /> KA 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, dean 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 /> CC Other(specify): <br /> 7. Electricity is provided for my booth's use. ❑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: ❑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 /> ❑ 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16.02 Page 7 of 11 TEMP EVENT APP <br /> =19119 <br />