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rr <br /> BAN-�J0A U U IN FnvironFnP taf' Heafth eparfime,-i - <br /> ._._.—C Q U N T <br /> TEMPORARY FOOD VENDOR'S APPLICATION. <br /> All food vendors(troth for profit and nonprofit)are required to return a signed and nompleted copy of this checklist to <br /> the festival coordinator three(3)%--eks prior to this event. Sundays <br /> 1. 1.fameofEver:T. oate(s),Year Round <br /> 2- The following is information about my organlzatinnJbirsiness: <br /> Llama of organizat!onlbusiness: ¢' �5 •. y ti:ry .- ". '- N.e, <br /> Address: 1-0 V ;:7 r <br /> Prone: 4dtematw. ( ) <br /> 3, List food to be sold or given to the public:_( <br /> 4. 1 am providing food that is NOT prepared at home: Yes 0 No <br /> A31 food 1s prepared on<slte or is from approved commercial facilities:Q Yes[I No <br /> Warne of fac�.� <br /> ay: <br /> _ I am pravidkiy a nth with the following.(to protect my urspad�. food and fc>i-preparation areas from r7", <br /> dust and tfS2 ) <br /> [I A booth with vraits and ceiling constructed of either wood,canvas, ptas�c, smL"r material and tine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooch and clearfabie floor(concrete, <br /> asphalt, clean tarps and smooth vrood are acceptable) and constnictod to separate food and food preparation <br /> arras from the public- <br /> []Other(specify): <br /> Note: The only operations not required to provide er)ciased booths are those which seff beverages from <br /> approved dispensers,or prepackaged foods from approved sous. <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(Spey)' <br /> 3 7. Electricity is provided for my booth's use:Q Yes❑No <br /> k3 8. 1 am providing an accurate prnbe fherrnometer to measum the trot and c L-Jd holding of potentietty hazardous <br /> foods during all times of booth operation:❑Yes 0 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 ❑Sterne R hotel trays <br /> ❑Double steamer El Steam table&lids <br /> Cl Electric stove top L-1 Other(Spey) <br /> Note: Examples of gotentlalty hazardous food include: meats, tarnates, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> M <br /> 1368 E. Hazeiton avenue I Stockton, California 9,9205 ) T 209 468-3420 ( F 209 464-0138 1 VAWJ.sjgov.orglehd <br /> EHD 15 02 Page 7 of Y 1 TEh3P EVENT APP <br /> �fi113114 <br />