Laserfiche WebLink
I <br /> S A N J 0 A U I N Environmental Health Department <br /> t�:j .b r�iKj .--.00UNTY--- <br /> Gr•ea tiras> grwy-s hare. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (bath 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,Namo of Event: F� ! r oatd{ ): �d S7 _2 <br /> i <br /> 2. The following Is information about my organ lzatlonitiLIS iness: <br /> Name of organizatiombusfness:)_ ' � Ce -L LC_ <br /> Addregs: <br /> l 1 4�•� c nl r . L !,� roC.k 5 r 2 <br /> t <br /> Phone: (209) 62..7- _79-3Alternate:( ) j <br /> 3. List food to be sold or IIlven to the publlo: — V SSV C� <br /> 4. 1 am provlding food that Is MOT prepared at home:,KYes 0 No <br /> Alf food is prepared on Mte oris from approved commercial fadllties:a-Yes❑No <br /> Narneoffacility; r fz./§LJPI EV '_1?C1 Phone: <br /> Address of facllily:2`;_q -S, 6(2/t 3 ALIG Star T l __.&f�4 C 5a <br /> 6. 1 am providing a booth with the following: (to protect my unpackaged food and food-proparetlon areas from flies, <br /> dust and the public) i <br /> ❑A booth with walls and ceiling constructed or either wood,canvas, plastic,similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanaWe floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to eeparato food and food preparation <br /> areas front the public. <br /> fr 01her(specify): R PK-rk1-) 00 <br /> Note: The only operatlona not required to prnvfde enclosed booths arc those which self beverages frorn <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinklmj, utensil and hand washing will be provided In my booth by the following rnethocl% <br /> a Approvod bottiod water. <br /> ❑On-site hose bib that Is connected to a potable water source. <br /> -Other(specify):,09� '6 1_ i - —--- <br /> 7. Electricity is provldad for my booth's use; Ll Yes No <br /> 6. 1 ant providing an accurate probe thermometer to measure the hot and cold hoktinof potentially hazardous <br /> foods during All tfman of booth oparatlon:C1Yesk4_No D0PNSW 'i 11PPk� C <br /> 9. 1 am provfding the follovring fiat temperature control for the hot holding of all potentially hazardous foods above <br /> 1359 F: <br /> ❑camp stove 0 Sterno&hotel trays i <br /> ❑ Double alearner 0 Steam table&lids <br /> El Electric stove top ❑Other(specify) i <br /> Note, Examples of potentially hazardous food fnclud©: meats, tamales, cocked boans, rice, <br /> vepatubfoa,potato salad,eggs, and(fairy products, <br /> 268 E. Hazolton Avenue 1 Stockton,California 96205 1 T 209 463-3420 I I: 209 46zl-0'138 1 wwW.$)gov.ovq/0hd <br /> EHO 10-02 TEMP EVENT APP <br /> 0710112028 <br /> I <br />