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SAN4 DAQUIN Environmental Health Department <br /> ;�. �. —COUNTY <br /> Greatness 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 /> i <br /> I 1. 1.Name of Event: WM Date(s):. <br /> 2. The following is information about my organ izationfbusiness: <br /> Name of organ¢ation/business: <br /> Address: C, <br /> Phone: (C bs- q�L S Alternate:( ) <br /> 3. List food to be sold or given to the public: L„v­,S :G -A':�- <br /> 4. 1 am providing food that is NOT prepared at home:dYes❑No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes❑No <br /> Name of facility: _ l �`s �c ±�: ,es Phone: _l (o 6-010 1 <br /> Address of facility: 1�'5S_ F ja.=--S7-ftf' --�,4��wa}' , CA41 gN,5'13 <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 /> B A booth with walls and ceiling constructed of either wood,canvas, plastic, similar material and fine mesh fly <br /> screening, compietely 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 /> L Other(specify): bA21, IEPc vsa mL Lw52:_ SC�+�,�t,F; 1�ozJo vg-A5H u.TnTa L <br /> 7. Electricity is provided for my booth's use: Ej Yes❑No <br /> B. 1 am providing an accurate probe thermomet r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:UYes❑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 � ❑Stemo&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.orglehd <br /> EHD iM2 Page 7 of 11 TEMP EVENT APP <br /> wrolao2s <br />