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Environmental Fleal€h Department. <br /> SAN JQAQUIN <br /> --C OU NITY— <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: I 'D [7ate(s}: <br /> 1 Drf zi Ztp <br /> 2. The following is information about my organ izattiion/business: <br /> Name of organization/business: -1! I C S cku1rno S <br /> Address: _y � V -GU o -ell VvG`�1 L�i'� C <br /> Phone: <br /> 3. List food to be sold or given to the public: grOS !(1 (*1�1� -.-w r G Cn} GAS <br /> 5UA3 <br /> 4. 1 am providing food that Is NOT prepared at home:[4 Yes❑No <br /> Al)food is prepared on-site or Is from approved commercial facilities:[Ayes❑No <br /> Name of facility: Phone:f-1 <br /> Address of facility: <br /> 5, 1 am providing a booth with the following:(lo 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 /> 10reening, completely enclosing open food areas. 11 will also have a smooth end 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 /> f. Approved water for drinking,utensil and hand washing will be provided In my booth by the following methods: <br /> J Approved bottled water. <br /> ❑On-site hose bih that Is connected to a potable water source. <br /> Other(specify): <br /> 7, ctricily Is provided far my booth's use: Yes[I No <br /> 8, 1 am providing an accurate probe thermorr�eser to measure the hot and cold holding of potentially hazardous <br /> foods during alt times of booth operation: Yes❑No <br /> 9. I am providing tho following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> r]Camp stove ❑Stemo&hotel trays <br /> ❑Double steamer ❑Stoam table&lids <br /> ❑Electric stove top j4 Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tarnales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 186B E.Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcolid.com <br /> FHe 1"2 Pepe 70111 1EMP EVENT APP <br /> 0713117 <br />