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SAN. JOAQUIN Environmental Health Department <br /> 1,4TY ---- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food venacirs,(both for profil and non-profit)are required to return a stgnel and completed copy of this checklist to <br /> the festival coordinator three.(3)weeks Prior to this event <br /> 1. 1.Name of Event-. <br /> 2. The following is information about my organ ization-rbusiness <br /> Name of organization/busifiess: <br /> Address: Z <br /> Phone: <br /> Alternate: ( <br /> 3. List food to be sold or given to the publir,: <br /> 4. 1 am providing food that is NOT prepared at home-0 yes[VI No <br /> All food is prepared on-site or is from approved corr.memat facilities: E3`Yes E] No <br /> Name of facility: P Df)611 r l .5-ril cl AA r-1 7_Phone: (, o 1 <br /> Address of facility:3 3 1() " T c X (11,u Q ks' 0 -T AA(- ;? C:A 'I <br /> 5. 1 am providing a boothw;th the following- (to protect my unpackaged tood and food-preparation areas from flies, <br /> dust and the public) <br /> lA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> craning, 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 ard food preparation <br /> areas from the public. <br /> Fj 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 pir­_,osed m my booth by the fol"%;inq methcds: <br /> 2� <br /> pproved bottled',ua ter. <br /> E]On-site hose bib r-liat is connected to a potable water source. <br /> Ej_ Otfier(specify): <br /> 7. Electricity is provided for my booth's use: Yes n No <br /> 8- 1 am providing an accurate probe Viermom er to measure the hot and cold holding of potentially hazardous <br /> foods during all times of bo-,th operation: Yes Ej_No <br /> 9. 1 am providing the following 1ot tem. peratur control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> r, Camp stove E]Slerm&hotel trays <br /> 71 Double steamer 0 Stearn table.,&lid-, <br /> AnE lectric stove top E-1 Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products, <br /> 1868 E. Hazeiton Avenue I Stockti:in,California 95205 1 T 269 468-3420 j F 209 464-013$ <br /> EHD 16-02 Page 7 of 11 TEMPEVENT App <br /> OV01t2024 <br />