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SAN JOAQUIN <br /> Environmental Health Department <br /> ' —COUNTY <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. <br /> DD � <br /> 1. 1,Name of Event: 'C� I Date(s): S <br /> 2. The following Is information about my organizationlbusiness: <br /> Name of organizationlbusines��syy: 5 <br /> j �,�e 1 sfri e <br /> Address: r <br /> Phone: (�3D Alternate: (6 j6 �' S <br /> 3. List food t be soldor ban to th ublic: S° Sou,✓ <br /> �durc& d c f n w �ee(s <br /> 4. 1 am providing food this NOT prepared at home: dYes%No <br /> P 9 — <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes P<'No <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5. 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 <br /> areas from the public. <br /> Other(specify); <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 wa r source. �}� Q <br /> Other(specify): I (T ( /�� J 5G Y ze Ct 6 ""'tux.( <br /> 7. Electricity is provided for my booth's ise: 0 YestM No <br /> 8. 1 am providing an accurate probe thermometer to measure the ho nd cold Id' g, f potentially hazardous <br /> foods during all times of booth operation: ❑Yes JZ No N/A VeOVIV 1VZ <br /> 9. i am providing the fallowing hot temperature control for the hot holding or all potentially jazardous foods above <br /> P g <br /> 13 FF: <br /> ❑ Camp stove ❑sterno&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑Electric stove top [Other(specify) JJ/4 <br /> Note: Examplos of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dalry products. <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 j www.sjcelid.com <br /> El U 18.02 Poon 7 of 11 TEMP EVENT APP <br /> P7W7 <br />