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h' <br /> N.. Q ,Q( � Environmental Health Department <br /> C0UN'T 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 /> 1. I.Name of Event: Date(s): <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organization/business: Kona Ice of Ripon <br /> Address: P.O.Box 1371 <br /> Phone: ( 209 ) 407-7044 Alternate:( 209 ) 302-9238 <br /> 3. List food to be sold or given to the public. Shaved Ice and Flavors <br /> 4. 1 am providing food that is NOT prepared at home: )Yes(]No <br /> All food is prepared on-site or is from approved commercial facilities:©Yes(]No <br /> Name of facility: Commissary El Gallo Phone:(209__334-2573 _ <br /> Address of facility: 355 N Guild Ave Lodi,Ca.95240 <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from fries, <br /> dust and the public) <br /> ❑A 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 /> t �— <br /> ❑x Other(specify): Truck &Id� L <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 bits that is connected to a potable water source. <br /> Other(specfy): 3 compartment sink 11 hand washing sink 1 storage tank on truck <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 ❑Stemo&hotel trays <br /> ❑Double steamer 0 Stearn table&lids <br /> ❑Electric stove top E❑Other(specify) Nothing Hot <br /> Nobs: (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) T 209 468-34201 F 209 464-0138 1 wwrw.sjgov.orglehd <br /> E1411 1G42 Page 7 d 11 TEMP EVENT APP <br /> ON19119 <br />