Laserfiche WebLink
TEMPORARY FOOD VENDOR’S APPLICATION <br />tName of Event1. <br />2. <br />Address: <br />Alternate: (Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />U-^A - <br />7. <br />8. <br />\ \o- ZH <br />S3 to- <br />)______ _ <br />H M <br />-----COUNTY------ <br /> Stemo & hotel trays <br /> Steam table & lids <br />S Other (specify) f/xi <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 209464-0138 | www.sjgov.org/ehd <br />EHD15-02 PageTcfll TEMPEVENTAPP <br />05/23/2023 <br />A <br />* V <br />C!^r\<A 1 S -e rjs <br /> On-site hose bib that is connected to a potable water source. <br /> Olher (specify): L-az~ <br />Electricity is provided for my boom’s use: @ Yes No <br />I am providing an accurate probe thermometer to measure me hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove <br /> Double steamer <br />Q Electric stove top <br />All food vendors (both far 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 />KI VER ISLANDS CFM <br />The following is information about my organization/business: <br />I*Name of organization/business: /*f CAf T <br /> <br />7^7 C fay 2^ & 7^ <br />(Ttf^ ) <br />< <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0"Yes No <br />All food is prepared on-site or is from approved commercial facilities: S Yes No <br />Name of facility: _Phone: (------)-------- <br />Address of facility:______ v n\q\o;\e Ccy4 me 1 <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 /> A booth with walls and ceiling constructed of either wood, can’ as, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also h; ve a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constjucted to separate food and food preparation <br />areas from the public. <br />0 Other (specify): jnobz/ <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 wffl be provided in my booth by the following methods: <br />Q'Xpproved bottled water. <br />Date(sXfa-