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i <br /> SAN <br /> —GOUNITY— <br /> I: Greol-n ss yrat•rs 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 LG F <br /> the festival coordinator thra weeks prior to this event. / <br /> 1. 1.Name of Even" r r2 t.e r /6:l !�'m[f tii�f'�T Date(s): <br /> M' <br /> 2. The following is information about my organization/business: <br /> Name oForganizationlpysiness: �� "i f S T � Xp <br /> Address: �?y � P'7fLCJGO< r 1_ r �5•'2�•'� <br /> Phone: (, SLA d ' Alternate:( ) <br /> 1 List food to be sold or given to the public: t')We c_v ,1 )EIze n L ('Ggk t'G.� �C3 fit' ,r,* j SSC^ <br /> 4. l am providing food that is NOT prepared at home:2 Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:0 Yes❑No <br /> Name of facility: ,S _, ' S ��' ��'� 6Phone: 20 <br /> � gla ' 06 0S <br /> Address of facility: e,- <br /> 5, <br /> /5, l 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): /n <br /> Note: The only operations not required to provide enclosed booths are those which seA beverages from <br /> approved disperise.rs,or prepackaged foods frorp approved sources. <br /> 6. •.--Approved water for drinking,utensil and hand washing will be provided in my booth by thefollow'Eng methods: <br /> ❑Approved bottled water. <br /> ❑On-"site hose laib that is connected to a potable water source. <br /> ❑Other(speclfy): <br /> " -"-- y,-�`-�I✓lectricfiy is provided-formy boofh`s use:El ❑No <br /> 9. i am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> 1 fo"ids durjng ail Mmes ot�btioth q�aralidn:[�Yep.❑fVo Y,__..., -, .:__ .. _ ._: ��,._•,�,,.._._ <br /> 9. 1 arra providing file folfowinghb ternpera`tiire conargl for tha I�ot Holding bf aU'potentlali}i Iia ardour fob"ds�}Sdv& <br /> 135"F; <br /> ❑Garbio stove ❑Sterna&hotel trays <br /> ❑Double steamer ❑steam table&lids <br /> ❑Electric stove top ❑ether(specify) <br /> Mote: t=Xamples of potentially hazardous food Include: meats, tamales, coalce4 beahsi rico, <br /> vegetables,potato salad,egg's,arld.dairy products. <br /> 1668 E. Hazelton Avenue I Stockton,California 95.2051 T 209 468-3420 F X19464-0138 1 www.sjcehd.corn <br /> EHA 16.02 0nae7'af 11 TEIufP r=1lENTAPP <br /> 0713117 <br />