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Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Marne of Event Datefs) <br />2 <br />Phone' <br />3 List food to be sold or given to toe pubfc. <br />4. <br />5. <br /> Other (speedy): <br />6 <br />9 <br />meats, tamales, cooked beans, rice. <br />7 <br />8 <br />SAN JOAQUIN <br />COUNTY <br />All food vendor? {both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Approved water for drinking, utensil and hand washing wtH be provided in my booth by the following methods <br />d Approved bottled water <br />tBSBE Hawtton Avenue StoO.tor- Canfomta 95205 | T 209 4G8-3420 | F 209 <464-0138 . www.sjcehd com <br />Pace - TFMP FvCNfT AJV <br />OTflVl? <br />Note; Examples of poientMy hazardous food include: <br />vegetablec, potato sated, eggs, and dairy products. <br />A <br />4^4■ <1*7 S^C/c-ri-e'rdo GA- <br />Note: The only operations not required to provide enclosed bectos are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />hot and cold hotting of potentially hazardous <br />___ Alternate ( ) ________________ <br />I .o/T J <2-1^ ( j <br />I am providing food that ® NOT prepared at home: Yes Q No <br />All food IS prepared on-Kte or s from approved commercial facarties^ Yes No Am’ <br />Name of facility Phone: ( > <br />Address of fadMy,_____________________ ___________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the put*c) <br />-W A booth with wafts and ceiting constructed of either wood, canvas, plastc, similar material and Sne mesh tty <br />screening, completely enclosing open food areas It wSi also have a smooth and cteanablc floor (concrete <br />asphalt cfoan tarps and smooth wood are acoeptatae) and constructed to separate food and food preparation <br />areas from the public <br />the festival coordinator three (3) weeks mcr to this event <br />The fallowing is information about my organizatramlxismess: <br />Name of rxganEatxxVbusness _ Gr-H U <br />Address 23 tOeftorrmS Cro-ss.rx <br />HG) 7’-l3-SC<72> <br />O On-site hose bib that is connected to a potable wwer source <br />^5 Other tspeofy)- .................... <br />Electricity ® provided for my booth’s use: Yes no <br />l am providing an accurate probe thermometer fo measure the <br />foods dwing all times of booth operation. Yes No <br />I am providing the fcaowtng hot temperature control for toe hot holding of an potentially hazardous foods above <br />135'F: <br /> Camp stove Q stemo & hotel treys <br /> Double steamer Steam tabic 8 Sds <br /> Bectoc stove top Other (specify)