Laserfiche WebLink
SANlOAgUIN Environmental Health Department <br /> - <br /> COUNT ) <br /> r« ,l1,15`.% <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profil)are rcclulrod to return a signod and complolod copy of this checklist to <br /> the festival coordinator three(3)weeks prior to Ihls event. <br /> 1• 1.Name of Event:�`1 l��_r�L__ PQr►n p V��1�FA12 Date(s): /0 "l ��f� I <br /> 2. The following Is information about my organizationlbusiness: <br /> NAme of organ izationlbuslness: SHE L e . .0 E A 2� <br /> Address: -7 95 S-r- e A 5T l.oeo Ce3SH3 <br /> Phone: ( (,(,t ) yj (o O 3 9 �r Alternate:( ) <br /> 3. List food to be sold or given to the public: LG MU,.r,er0 E rC 0 O 7-b.4 <br /> 4. 1 am providing food that is NOT prepared at home:EfYes❑No <br /> All food is prepared on-site or is from approved commercial facilities:['(Yes❑No <br /> Name of facility: 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 /> 54"A 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, clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> ❑Other(specify): <br /> Nate: The only operations not required to provide enclosed booths are those which soil beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> ❑Approved bottled water. <br /> R(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: YJ Yes❑No <br /> 8. 1 am providing an accurate probe thermorneV to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: 9 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 /> ❑Camp stove N! ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: lneats, tamales, cooked beans, rice, <br /> vogotables,potato salad,eggs,and dairy products. <br /> 18H E. Hazellon Avenuo I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www,sjgov.orglehd <br /> tEr10 tf3-0 Page 7 of I 1 TCMP EVENT APP <br /> 1pM0 <br />