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ir <br /> I ; �• l� r � �.., �r _ _ �r'.���� ate_ � !t•� } � <br /> y S J DAW N Environmental Health Department <br /> � .'1, _ COUNTY <br /> t rrntn sz gro.+s h,_ <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (bVh for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator thre 3)% e ' prior to this event. Webei;Ft0 r#,g r s s arket Sundays <br /> fiq;w� O� - fl1.Name of Event- _Date;s!h ���"� <br /> z. The following is infonnatlorl about n rani io ! isines5; 1 <br /> Name of vrgani7al= busii 4 <br /> Address. <br /> Phone: (��} '�=��J Alternate <br /> ice,�oKr- -G t K A oR 4 <br /> 3. List food to b w sold or en to the pubtic: lC fF�kl 5 T <br /> � i?SK�� Ti iC (�[�It <br /> I aT c T+�b wJl�plA, pi>Jc l Rt c c c�P�It'O,CA5 G414L�� I QPA <br /> 4. 1 am providing food that is NOT prepared at home; 'Yes ❑ No <br /> Atl food is prepared on-site or is from approved commercial facilities: ❑Yes❑ No <br /> Name of facility, Phone: 1 <br /> Address of faci€ity- <br /> 5. 1 am providing a booth with the following (to protect my unpackaged food and food-preparation areas from fTtes <br /> dust and the public) <br /> ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine rresh 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 prepare#ton <br /> areas from the publ'.c. <br /> L/Olhel tswif„). W ISU,9 ATA4 T #K µMTS A I REV.STI4TEP A&Vt. <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 /> S. Approved water for drinking, utensil and hand washing will be provided in my booth by the folf4vnric methods <br /> `Approved bottled water. T <br /> ❑Ors-Site hose bib that is connected toa potable water source. �l <br /> I Cher(spatify} N tlL� p � /� U f � <br /> T Electricity is provided for my booth's use,',use,'M Yes }Tlo — <br /> 8_ 1 am providing an accurate probe thermometer to rnoasure the hot and cold holding of potentially hazardous <br /> Foods during ail times of booth operation: Voyes❑ No <br /> 9, !am providing the foRowing hot temperature control for the hot holding of aU potentially hazardous foods above <br /> 135'F: <br /> Camp stove E)Stemo&hotel trays <br /> ❑ Double steamer 'Steam table&lids <br /> ❑Electric stove top VOther(specify) C <br /> fbT-J . <br /> Note: Examples of Potentially hazardous food include: moats, tamales, cooked beans, rice, <br /> Vegetables,Potato salad,eggs,and dairy products. <br /> 1869 E.Hazetton Avenue l Stockton. California 952051 T 209 468-34201 F 209 464-0138 1 %vwvr.slgov.cra'ohd <br /> r;.ij,t.r,r <br /> - <br />