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r <br /> 7an.20.2020 03:02 PM DYER 2096972885 r 9/ 5 <br /> a <br /> S A N d 0A 0 u 1 N Environmental Health Department <br /> (. .<..)U i`.I I' Y <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 /> I. f.Name pf Event: <br /> 2. The following is information about my organization/business: <br /> C �� ��sS+ t A S]"G <br /> Name of orgenizatlon/business: � <br /> Address: ")-3 5' c rc� lac► N i , +��� C r� !i s &7 <br /> Phone: { rf ) I - 5�j Alternate:(S +0 ) 1 t <br /> 3, List food to be sold or given to the public: lea - <br /> 4. 1 am providing food that is hibT prepared at home:(]Yea q No <br /> All food Is prepared on-site or Is from approved commerclai facilities: [3 Yes Q No <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5, 1 am providing a booth with the following; (to protect my unpeckaged food and food-preparation areas from flies, <br /> dust and the public) <br /> AsoA booth with walls and ceiling constructed of either wood, canvas, plastic,similar material and fine mesh fly <br /> ening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, cleah tarps and smooth wood are acceptable) and constructed to saparate food and food preparation <br /> areas from the public. <br /> 0 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 Born approved sources. <br /> 6. Approved water for drinking,utensil`i�and hand washing will be provided In my booth by the following methods: <br /> [I Approved bottled water. l K <br /> [] On-site hose bib that is connecteted to a potable water source. <br /> ❑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 Lj 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 /> [J ramp 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. Hacelton Avenue I Stockton, California 95205 I T 209 468.3420 ( F 209 464.0138 [ www.$) ov.org/ohd <br /> EHp 18.42 P000 7 of 11 TEMP EVENT APP <br /> 06114/19 <br />