Laserfiche WebLink
SAN.>JOAQUIN <br /> Environmental Health Department <br /> ��• � .1 <br /> —COU[,ITY <br /> ` Gr 'u[nrsc ,frnrrt lie,r. <br /> TEMPORARY FOOD VENDOR'S APPLICATION )1�( �Y`�f <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.Nome of Event: 1( ' � nD'Qate(s): td-102. The following is Information about my organlzationlbusiness: f V`�� <br /> Name of organ izatirtionlbuslness: -PJ T 6t1 <br /> Address: 4U 5 C. 1 1 , #/2 <br /> Phone: ( ( ) J'_'�i` I `� C Alternate..( ) <br /> 3. List food to be sold or given to the public: <br /> 4. l am providing food that Is NOT prepared at home:0 Yes❑No <br /> All food is prepared on-site or is from a pro ed commercial facilities:❑Yes❑No <br /> ti <br /> Name of facility: en Phone: <br /> Address of facility: 412Na C-1 <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): C VYLA <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-slle 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. I 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❑Na <br /> 9. t 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 /> 1668 E. Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 208 464-0138 j www.sjcehd.com <br /> EHD 18-02 Pago 7 of 11 TEMP EVENT APP <br /> 07W17 <br />