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SA N 1 U A U U I N Environmental Health Department <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 f Name of Event: t��ti� S' (� T ^�Y Date(s) la �'_J <br /> 2 The following Is Information about my organ izatlonlbuslness <br /> Name of organ izationlbusi ness 0k L,� J <br /> Address <br /> Phone ( )- �ItUM Alternate`( } <br /> 3 List food to be sold or gwen to the public �� .tt , J�1 nc� <br /> l <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 facditiesl�6es❑No <br /> Name of facility Phone: <br /> Address of facility <br /> 5 1 am prowd�ng 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, 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 foods from approved sources. <br /> b Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods <br /> Approved bottled water <br /> "f� -site hose bib that is connected to a potable water source. <br /> ❑Other(specify): _ <br /> 7 Electncity is provided for my booth's use: Yes❑No <br /> 8 1 am providing an accurate probe therm eter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation S"es❑ 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 ❑Sterno&hotel trays <br /> ❑Double steamer ❑Slearn table&4ds <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1865E HAlmltov Avc;nue I S1u(.ktUi1 (':1I1fnn: •I"Zell, t '01 4FIM 14201 F I www slcehd com <br /> EHD Ig Oz Nay"r of+ TEMP EVENT APP <br /> 97IsI <br />