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SAN JUALWIN Df-1palllyloflf. <br /> t (_;I )1\1 ! Y <br /> TEMPORARY FOOD V NDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit)pre required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior In this evertl. c <br /> 1. 1.Nance of Event- �c�r C�f �"7~ 1– /- __-_—_ Dates;3 3/D_hJ ZnZ <br /> 2. The follovring is information about my WflMIZaliOnIbusirless: <br /> Name of organizationA)usiness: ' « i.!riN��f ,}+ ✓vI ��f, rE <br /> Address- )c�j S' L• �y._PI.">._.r"v�.��'.� V"11 =' Y". <br /> Phone: i� )� ;���.�� � — Alternate. )�// ��7– 9 �R� <br /> 3, List food to be sold or given to ilio putilir.:Ll V jf% Sf., -I r -''e- C.. f _ .'._l1_w f : 2�/r E <br /> 4. 1 am providing food that is N01'preparefi at home D Yl-s L Mi <br /> Alk food is prepared on-site oris from appfuved commercial facil1lies:r Yes f rj►+)p <br /> Name of facility: - �..�. ._ _ _ _ Phone: <br /> Address of facility._._ <br /> 5. 1 air}providing a bootri with the fo!lolrring:(to protect my unparkaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with wails 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. 1 <br /> C,1 0t-her(spe0y): f'4t <br /> Note: TI)e only operations not required to provide enclosed booths are those which sell beveragr:s from <br /> approved dispensers.or prepackaged foods from approved sources. <br /> 6 Approved wale,for drinking, utensil and hand washing will be provided in my booth by the following rnethods- <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> / <br /> Other(specify): <br /> 7. Electricity is provided for my tooth's use: Yes El No <br /> a. I aril proviGing an accurate probe therrnonieter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation,U Yes D No til <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> L;Camp stove ❑Slerio&hotel trays <br /> C Double steamer U Steam labia&lids <br /> ( Electric.stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: rneats, tamales, cooked heans, rice, <br /> vegetables, patatn salad,eggs,and dairy products. <br /> 1868 E. t-lazeltori Avenue I Stockton,Galiforma 952061 T 209 468-3420 1 F 209 464-0138 1 www.sjcelid.corn <br /> FHO A-U 1 11 TF-MP EVEN T AP' <br /> nnanT <br />