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i Environmental Health Department <br />Date(s):1. <br />2. <br />Name of organization/business:. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />Alternate: ()____ <br />S i a-e <br />SANJOAOUIN <br />------COUNTY------- <br />Greotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify):_____________________________ _____________________________________ <br />Electricity is provided for my booth’s use:O Yes bJ'No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />I am^roviding thVfollowhig hoUemp^rS hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp st ove Sterno & hotel trays Steam table & lids <br /> Double steamer IHfother (specify) f(a*. 0 S4ovd. <br />n Electric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />■J-/J <br />(2x00 ) 32-1 S7 3 __ <br />List food to be sold or given to the public:. <br />I am providing food that is NOT prepared at home:LyfYes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: <br />Address of facility: Q/iric o do. hA&sjC> " zin. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />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 />[—I 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />I Ln <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. Name of Event: <br />The following is information about my organization/business: <br />P< 2-2^. KA <br />H'Yes No <br />_Phone: ()