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SAN JOAQUIN RAVIronm+�:ntcd NOV <br /> ����rr',�rr�w�i <br /> ---COUN �— <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 /> ;he festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: Date(s): <br /> 2. The following is Information about my organization/business; <br /> t <br /> I lame oforganizizatioonlbusin/eess:,Rk e-� s�ces-s.1 Q, s D1 PP,id <br /> Address; I ! l A eQL Y J A A09. C(.+ O-Z / <br /> Phone: (50). 3 0 7 S 4 3 8' CK't 9A AHeirnate:(Gil) .29F- a 99 9 (,7t.r ,) <br /> 3. List food to be sold or given to the public; UP 1 K' Te 1Lc &Cm4 <br /> 4. 1 afn providing food that is NOT prepared at home:❑Yesk0 <br /> All food Is prepared on-site or is from approved commercial facilities;)dYes❑No <br /> Name of facility: tl`S LA _. . 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 /> ❑ A booth with wails 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, r ' �, <br /> Other(specify): ���� — f u '�Y'/ C�" 60SO' <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 /> AOther(specify),. C f T W fG 7-1611- <br /> 7. <br /> CIZ7. Electricity is provided for my ooth's use: Yes❑No <br /> 8. 1 am providing an accurate probe thennomete o measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:ltffYes❑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 ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other(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 952051 T 208 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHE 78.42 Page 7 of 11 TEMP EVENT ARP <br /> Q713117 <br />