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SAN J OAQU I N Environmental Health Department <br /> - -COUNTY- <br /> i,aeatness elroos f7B1'C <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 thiZL <br /> 1. 1.Name of Event: �Ocl t SA< l�LL __Date(s): <br /> 2. The following is information about my organization/business:J <br /> Name of organization/business: lC ��1y i l V <br /> Address: Jl b RJ�', SJ( 2 <br /> Phone: ( ) J �I �` � ` Alternate: (, [O} _ 1�2 � <br /> - <br /> 3. list food to be sold or given to the public: t ( 1 5�11 ".� ���� lJtbYUJ Go S <br /> 4. 1 am providing food that is NOT prepared at home: l2q Yes ❑ No <br /> All food is prepared o i site or is fro approv dcommercial facilities: Yes ElNo <br /> Name of facility: Phone:LX�`'�i <br /> Address of facility: 206 � `C <br /> .S. 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 n <br /> areas from the public, 5)1j <br /> -ther(specify): �J�C a*` I — NO rt <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-site hose bib that is connected to a potable water source, <br /> ❑ Other(specify): <br /> 7, Electricity Is provided for my booth's use: ❑YesNo <br /> 8. 1 am providing an accurate probe thermometer 71ror <br /> aSLlre the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: El YesNo <br /> 9. 1 am providing the following hot temperature cont the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids IJIA <br /> ❑ Electric stove tap ❑ 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 209 464-0138 1 www.sjgov.org/ehd <br /> EHb 16-02 Page 7 0111 TEMP EVENT APP <br /> 0710112025 <br />