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SA N J OA Q U I N Environmental Health Department <br /> ` COUNTY <br /> { Greatness grows here. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ail food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordin%orthree(3�weeks prior to this event. <br /> 1. 1.Name of Event: $ cn__d_��o��� M �eS�l I� Date(s): 4o�p <br /> 2. The following is information about my organization/business:/ <br /> Name of organizationlbusiness.Cin.C, <br /> Address: ' a L, <br /> Phone: ( �7) � _ Alternate: ( } <br /> 3. p t food to b Id o ive to the public.� c4 C i-ej CkcC G , fi e �r�'114� <br /> 4. 1 am providing food that is NOT prepared at home: Q2"&s❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ffk�es[] No <br /> Name of facility: s_ u( a Phone:fGOVO <br /> Address of facility: G <br /> 5. 1 am providing a booth with a following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> [booth with wails 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 /> Reproved bottled water. <br /> u6n-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: es❑ No <br /> 8. 1 am providing an accurate probe thermometey#o measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: UYesEj No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135OF: <br /> ❑Camp stove [tttemo&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 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHO 16.02 Page 7 of 11 TEMP EVENT APP <br /> OR119l19 <br />