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~ »■ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event:1. <br />2. <br />^53 bQAddress: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />p^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />UHH JVMMV < 11 <br />-----COUNTY----- <br />Vrs'. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd EHDIMC PaseToMI -reMPEVENTAPP <br />06^2023 <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes C No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: QTYes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />O Camp stove (3stemo & hotel trays <br />[^dJouble steamer (^Steam table & lids <br /> Electric stove top C Other (specify) <br />AH 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 />Date(s): 4/27- <br />The following is information about my organization/buslness: <br />Name of organizafion/business: (t <br />yt( ,/V Manley eJ RC <br />Phone: < filb ) 0 Alternate: ( )--------------------------------------- <br />List food to be sold or given to the public: ^0 <br />I am providing food that is NOT prepared at home: D No <br />All food is prepared on-site or is from approved commerdai fadlrties:Jp'Yes O No O h lJ <br />Name of facility: Phone: (2.^) ------------- <br />Address of facility: I tU AJ S ----------------------- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br />dust and the public) <br />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.