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AN J O AQ U IN Environmental Health Department <br /> C O 1-1 i _. <br /> TEMPOW RY 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 /> 1. 1.Name of Event: il r <br /> 2. The following is information about my organization/business: <br /> Name of organization/business ) OSA -- N- Mom <br /> Address: <br /> S'Sr'U <br /> Alternate: ( ) <br /> Phone: O _ <br /> 3. List food to be sold or given to :he public: P LJ ! + <br /> 4. 1 am providing food that is N01�prepared at home:'MYes No <br /> All food is prepared on-site or is from approved commercial facilities. N Yes❑ 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 /> \D-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 water source. <br /> ❑ Other(specify): _ <br /> 7. Electricity is provided for my h3oth's use: [3..Yes ❑ 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: (KYes ❑ 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 ❑ Steam table&lids <br /> t�jflecthc stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs, and dairy products. <br /> 1858 E. Hazeiton Avenue ? Stockton. California 95205 T 209 468-3420 } F 200 464-0138 j www,stgov.orglehd <br /> EHD 16-02 Page 7 of 11 07/01/2024 TEMP EVENT APP <br />