Laserfiche WebLink
fln vironrn n aP Health Depr oyentSAN 10AgUIN <br /> .......C aU NIT Y----- <br /> 0(10MISS hot'. <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 checidist to <br /> the festival coordinator three(3)weeks prior to this event. _f <br /> 1. 1.Name of Event: V- � - pale(s); fJ <br /> 2. The following Is information about my organizationibusiness: <br /> Name of organkzatronlbusiness: f D e4-cl --Q"/ / <br /> Address: / 1 <br /> Phone: ( `� 7 l�,L�_ _ AkernaatE:( ) <br /> 3, List food to be sold OF giver;to the public' <br /> 4. 1 am providing food that is NOT prepared at home:Pg Yes❑No <br /> All food is prepared on e a is from appy ved COMM rclol facilities:W Yes ElNo <br /> Name of facility: r -4E ,Phone: ) - <br /> Address of facility: <br /> 5, 1 am providing a booth with the following:(to protect my unpackaged food and food-preparsfion areas from flies, <br /> dust and the pub5a) <br /> ❑A booth with walls and celling constructed of either vrood,carrvas,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 arceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> { Other(specify): DA A �r Q '-4 pui k,5 <br /> Note; The only operations not required to provl enclosed boolhn are those uAlch sell beveragesi from <br /> approved dispensers,OF prepackaged foods from approved source-3. <br /> 6. Approved water for drinking,utensil and hand washing-.-All be provided In my booth by the follovAng 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 booWs tree:❑Yes[]No <br /> 8, 1 am providing an accurate probe Mermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all tunes of booth operation:g Yes 0 No <br /> 9, 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 935°F: <br /> [D Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other(speclfy) <br /> Noto; Examples of potentially hazardous food include: meats, tarnales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy product,, <br /> 7858 E.Hazelton Avenue I Stockton,California 952051 T 209 48&347.0 I P 209 464-0938 1 -.•nrvj.sjcehd.com <br /> F110 IC-02 Poga 7 of 11 TEMP EWOT RPP <br /> 47!3!17 <br />