Laserfiche WebLink
SAN J OAQ U I N Environmental Health Department <br /> ---COL N-f-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 chest to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event:'ClAi S�ree-�- Date(s); <br /> IA <br /> 2. The following is information about my organization�ibbY"ujsiness: ` <br /> Name of organization/business:_-1-MQ e � y't(& <br /> Address: G'-4� --L CCW _k& -St— "0�j 10 n j <br /> Phone: qq [ � f�v/ Alternate: <br /> 3. List food to be sold or given to the public: l' <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities: Yes❑No � <br /> Name of facility: Phone: <br /> Address of facility: Crib <br /> 5, 1 am providing a booth with the foll win : (to protect my unpackaged food and food-pr aration areas frort�flies, <br /> dust and the public) , (� <br /> ❑A booth with walls and cel[Ing 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): <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 /> [j Approved 1 1 lApproved bottled water. k— <br /> F1 <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 OTNo <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 fallowing hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> 1 f <br /> ❑Camp stove E)Sterno&hotel trays OV <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 95208x1 7 r 209 468-3420 1 F 209 464-0138 J www.sjcehd..oi-nEVENAPP <br /> EHo 16-02 <br /> 07131 f7 <br />