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4113126,3:48 PM crkcxxrkdeng1bugcyir.jpg(30204032) <br /> SAN 1 Q A Q U I N Environmental Health Department <br /> _. _C CSU N---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 checklist to <br /> the festival coordinator three(3)weeks prior to this event, Y1; ILS�t ISD <br /> .I <br /> 1. 1.Name of Event: {A� Ad Date(s): <br /> 2. The following is information about my oTgan17aVonlbuslnes/ss: i ��as�c� t—U?� �`� <br /> Name of organization/business: <br /> Address: <br /> �l <br /> Phone: <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at horne:�Nyes❑ No <br /> All food is prepared n-site or is from aproved commercial facilities::Yes❑ No <br /> Name of facility: `•L. Phone: (/- <br /> Address <br /> /Address of facility: L4 1p f rb" I'd SL�!1 Y�,��_l�c. CA <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from hies, <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): _(� ..l _-- <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 wateFfgr 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: 0 e No <br /> 8. I am providing an accurate probe thermometer IQ easure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes No IJ A <br /> 9. 1 am providing the following hol temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F; <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Stearn table&lids <br /> ❑Electric stove top x0ther(specify) N A. <br /> NOW: Examplas of potentially hazardous food Include; meats, tam alas, cooked beans, rice, <br /> vegotablas,potato salad,eggs,and dairy products. <br /> 1868 E.Hazelton Avenue I Stockton, California 952051 T 209 468-3420 F 209 464-0135 1 wwyv,sjgcv,orglehd <br /> srta 1a�z p5ga 7 or 1 i <br /> Mln,a� <br /> TEMP EVENT APP <br /> https:Tlres.cloudinary.comlconvuntlonforcehmayelupload/v1769126854/crkcxxrkdengibug cylr jpg 1� <br />