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SAN �JUAQUIN Environmental Health Department <br /> C0U1`\lTY-- <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: Date(s). -!"M <br /> 2, The following is information about my organization/business: <br /> Name of organizationfbusiness:_ Drea's Kitchen <br /> Address: <br /> Phone: ( ) Alternate: ( ) II <br /> 3. List food to be sold or given to the public: ' Y1 i <br /> 4. I am providing flood that Is NOT prepared at home:[I Yes�o C.� �J 71 �j <br /> All food is prepared on-site or is from a roved commercial facllitles:❑ ?VNo <br /> Name of facility: l `t Phone: ( 1 <br /> Address of facility: <br /> 5. !ann providing a booth with the follow€ng: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ®A booth with walls and telling constructed of elther 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): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages ram <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 wter source. <br /> gBectricity <br /> Other(specify):7, Is provided for my oath's use: LJ ❑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 /> [❑camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids �� E! <br /> F-1 Electric stove top Vther(specify) p�pa <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E.Hazefton Avenue I Stockton,California 952051 T 209 468-3429 I F 209 464-0138 I www,slcetid.com <br /> EHD 16-42 Page 7 of 11 TEMP EVENT APP <br /> 0711117 <br />