Laserfiche WebLink
SAN JOANIN Environmental Health( Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors{bath for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the Festiva€coord;nator three(3)weeks prior to this event ��yy <br /> n 4 � <br /> t 1 Name of>;vent: � ��L:� d Date(s) Z-a <br /> 2 The following Is information about my organrzatlonibusrness <br /> Name of organtzationibusiness `` <br /> Address CT ClCIc <br /> Phone (�.Gc1) ( Alternate:1 ;Lcf? <br /> 3 List food to be sold or given to the public -< L <br /> 4 1 am providing food that is NOT prepared at home:f�Yes❑No <br /> All food is prepared on�eor Is from approved commercial facilities Yes❑No <br /> Name of facility N),�2c _ Phone <br /> Address of facility <br /> 5 1 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 ceding 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. 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 fcxAs from approved sources <br /> 6 Approved water for drinking,utensfl and hand washing will be provided in my booth by the following methods <br /> jj 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 9 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 r�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 /> [�Carnp stove ❑Slemo$hotel trays <br /> ❑Double steamer ❑Stearn table&lids Nl(k <br /> [�Electric stove top Other(specify) \C '- �COh1 <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> IBM E.HaZo inn Avarwe I Stockton."ifornia 06205 1 T 209 4&D,3430 M F 209 464,0138 1 www sicohd com <br /> Intl t N NAv&r cr I EIUP N+ j1r„ <br /> pt'alf r <br />