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SAN J O A Q U 1 N Environmental Health Department <br /> C O U[,,)'I Y-- <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 10 <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: LD�d <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organization/business: 1 r-&A--_A'17-e Jowe— <br /> 6-4 C <br /> Address: 1� r° DD � � l <br /> Phone: 71a — 1,3► " /� Alternate: ( } <br /> 3. List food to be sold or given to the public:M dd S r 'y A0 beMe 5 <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes XNo <br /> All food is prepared on-site or is from approved co Tlmercial facilities:�jYes❑ No <br /> Name of facility: ��� r- Phone: <br /> Address of facility: � e <br /> ll <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, completeiy enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean larps 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 /> 6. Approved water for drinking,utensil and hand washing will he provided In my booth by the following methods: <br /> Approved bottled water. -Pr- ,� <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> Lj Camp stove ❑Sterna&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑Elertric stove top (J 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 95205 1 T 209 468-3420 1 F 209 464-0136 1 www.sjcehd.com <br /> DID 16-02 Para 7 of 11 TEMP cvcN'r APP <br /> 07!3117 <br />