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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event <br />2. <br />Name of organizatiorVbusiness: <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />Q Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />meats, tamales, cooked beans, rice. <br />O <br />OS-Q.°t "St t-2. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />The foliowing is information about my organization/business: <br />DuT <br />- -COUNTY----- <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\aJ <br />S \ \ x \J c\ \\e^ <br />1 O o z- <r <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />O 7 <br />An 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 />7. <br />8. <br />r* <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />EHO16-02 Page 7 off 11 TEMP EVENT APP <br />06QSOJ23 ------r- \ ,A _ <br />SB <br /> Other (specify): ✓_ ____________________- ------ -- <br />Sectrrdty is provided for my booth’s use: Yes 0 No <br />I am providing an accurate probe thermonetej to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ©Yes O 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 /> Electric stove top <br />Date(s): 4/^7- <br />E?Yes No <br />Phone: (^(>6) 7^ A- pOH 3 <br />_____________ S u>1 —* <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />du^t 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 endosing 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 horn the public. <br />7 rtpw M Ca;T ______ <br />(Irf-yD ) UiH ' #431_________________ Alternate: ( <br />List food to be sold or given to the public: t-tUaT <t J <br />I am providing food that is NOT prepared at home: ^fves No <br />Ail food is prepared on-site or is from approved commercial facilities: <br />Name of facility: I SoS KA T <br />Address of facility: i'T <?