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-� S A N J O A Q U I N Environmental Health Department <br /> Greatness prows here. <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. 1.Name of Event: "44 Date(s): <br /> 2. The following is information about my Jorganization/business: <br /> Name of organization/business: 7147b y!> ir _ <br /> Address: <br /> Phone: (�-�7') IV4 3 Alternate: <br /> 3. List food to be sold or given to the public: �� �'`,.s(ei, 1<'fFzG�4►� k.: g(�S ��C <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 facilities: Ef Yes❑ No <br /> Name of facility: {�'� � 6 � "/� C�:a Phone: <br /> Address of facility:�+w 2 r �c� / 'j�Lr, e.cr t L Y3, `is Z 3 <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 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 /> 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. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> [Approved bottled water. <br /> []'On-site hose bib that is connected to a potable water source. <br /> Z Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes❑ 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: ❑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 [TStemo&hotel trays <br /> ❑ Double steamer ❑Steam table&lids _ <br /> ❑ Electric stove top 50ther(specify) ,-� <br /> Note: Examples of potentially hazardous food include: meats, [tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs, and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 07/3/17 <br />