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SAN JOAQUIN I-111r1!'t)till'1ent al t-Irsalth Df.poi #.frlf:nt <br /> I <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profil) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior tto.this event. <br /> 1 1 Name of Event- iii Ty' " n Date(s). <br /> 2 The following is information about my organization/business: <br /> Name of organization/business' <br /> Address: 6t �I ZKa <br /> Phone. —?261 Alternate. ( ) <br /> 3 List food to be sold or given to the public, <br /> 4 1 am providing food that is NOT prepared at home:PYYes❑ No <br /> All food is prepared on-site or is from approved commercial facilities PYes❑No <br /> Name of facility TM'P, • Phone: AW ! <br /> Address of facility: t2_3 k u. CLAA t6of 6ft R 7_`sy <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) , 'W_ - <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 /> A Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source <br /> I Other(specify)-� `f L&' <br /> 7 Electricity is provided for my booth's use ®Yes❑ No <br /> 2 I am providing an accurate probe thermometer to measure the hot arid-cold holding of potentially hazardous <br /> foods during all times of booth operation [KYes ❑ No <br /> y I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135''F <br /> ❑ Camp stove H Sterno& hotel trays <br /> U Double steamer Steam lable&lids <br /> I ) f-lerlrK:stove tofu tither(specify) <br /> fdufe: Example-, of potantially hazardous food include: meets, tanialos, cooked beans, rice, <br /> vegeiahles, polato salad,eggs, and dairy products. <br /> IJir)?S t l i:�/Uih�fi/'/i 11 li. + :iliu,N hurl (.,Alowla 16M!{[ T ;�(I!i�I{i;i i f:'tl I l` ;7(}�I-lt 1 it l:;moi I t411w -+Jov hl�l t 11j <br /> Klip!7 nr I I I I Ah'IVI hl AI-0 <br />