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&- -AA.N.aj0 AOVI N' Environmental Health Department <br /> UV . ...... : <br /> AN <br /> N <br /> .. ......... .. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ali 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. /a <br /> 1 1.Name of Event: 0 ate(s): J02-0 <br /> r <br /> 2. The following is information about my organization/business: <br /> — 8ams <br /> Name of organization/business: rxx <br /> Address: 5-1,5b <br /> Phone., (51 o) -1,3o --M�( Afternate:'(510 <br /> 3. List food to be sold or given to the public: M& SoLu ce-s So re-s n nd nAbs <br /> 4. 1 am provldlng food that Is NOT prepared at home: 01yes D No <br /> All food is prepared Is from approved commercial facilities: / <br /> red on-si e oMEl Yes No <br /> Name of facility: FG-01S Phone: q g!� <br /> Address offeclllty: 10081 4ve, OA. <br /> 5. 1 am providing a booth with the following, (to protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> El A booth with walls and celling 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): (6a <br /> (60CV- toajA__, <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 /> E]Approved bottled water. <br /> D On-site hose bib that is connected to a potable Water source. <br /> N(Other(specify): W /A <br /> 7. Electriolly Is provided for my booth's use: 0 Yes F1 No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation, Ej Yes n No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> ❑Double steamer F-1 Steam table&lids <br /> F1 Electric stove top EKQther(specify) KIA iI <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 952051 T 209 468-3420 11= 209 464-0138 1 www.sjgov.org/p-hd <br /> EHD 1e-02 Pago 7 of 11 TEUP EVENT APP <br /> 07101!2626 <br />