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a ( Environmental Health Department <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)we eks prior to this event. <br /> r <br /> event. � 7 <br /> 1. 1.Name of Event: - U RC'A j u�� rJ Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: � N A)Al/H) G't{/S fN�-t-i0b <br /> Address: 11-6{ We `1� �a �� ,7�` / `y L , Jb1�� 1 i CJe <br /> Phone: (.,c?�) I - ( -�( S Alternate: ( ) <br /> 3. List food to be sold or given to the public. f4-�k FX <br /> 4. 1 am providing food that is NOT prepared at home:Yes ❑ No <br /> All food is prepared on-site cr is from approved commercial facilities-Yes ❑ No <br /> Name of facility: 1 Ukjjo6 tj Phone: (22$ �--01 �3 3 <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 /> Jc1rA booth with walls and ceiling constructed of either wood; canvas; plastic. similar material and fine mesh fly <br /> eening, 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 ccnnected to a potable water source. <br /> ❑ Other(specify) <br /> 7. Electricity is provided for my booth's use: Yes ❑ No <br /> 8. 1 am providing an accurate probe thermom ter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation]Yes ❑ 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 ❑ Stemo &hotel trays <br /> ❑ Double steamer Steam table&lids <br /> ❑ Electric 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 /> ?868 E. Hazeffon Avenue ; Stockton. California 95205 T 209 468-3420 F 209 464-0138 www.$)gov.org/ehd <br /> EHD1"2 Page 07/01/2024 9 TEMP EVENT APP <br />