Laserfiche WebLink
SAN.10ANIN Environmental Health Department <br /> 'COUNTY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> 411 food vendor,(troth for profit and non-pt00 fire rcquiretl to return A Signed and comWeled cagy of this checklist to <br /> the festival coordinator three(3))/ 1110weeks:prior to this event. <br /> 1 1.Nerneof Evenl: ���f [r(f�U Vi•! z/,V/? . Date(s): <br /> 2 The fotlo%4ng i.$Information above my organizatiordbusiness: 1� <br /> Name of organizatronlb siness: ltl ff £ o l��/�`J/(F/-) <br /> Address: ` �, Y j d�'j <br /> { r <br /> Phone: � ) � 0 Jllternate:t ) <br /> 3. List food to be sold or given to-the publ' w/17 <br /> 4. f am providing food that Is NOT prepared at home:❑Yes No <br /> All food is prepared on-site or is from approved oom ar •al facilities:a Yes 0 No <br /> Name of tatxlity. G t`G ` f Phone: r).�, / �•-Z <br /> Address of tap'!' <br /> y — 15, <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparaWn ar rorn(ties, <br /> dust and the.public) <br /> A booth wfth walls and ceiling constructed of either wood,canvas.plastic, similar material and fine mesh try <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®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: 11 Yes❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 9 35°F: <br /> ❑ <br /> ❑Camp stove Stemo 8 hotel trays <br /> ❑Double steamer IF Steam table 8 lids <br /> 0 Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> Yegetables,potato salad,eggs,and dairy products. <br /> 76 E. lia Etitarl AvenueStockton.CaWorfga 9520 par �.209 468-34201 F 209 464-0138 1 wvvw.s ar AM <br /> so%sW <br /> pa,•is+f� <br />