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SHIN JOAQUIN Environmental F-Iealth 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)weeks prior to this event. <br /> 1. 1.Name of Event BOPS& OBLINS BREW FEST Date(s)OCTOBER 28,2023 <br /> 2. The following is information about my organi2allon1business:Name of/organization/business: <br /> Address: e7&c_; - i ed.1 k U el <br /> Phone (20f)) 6J06 <br /> 3. List food to be sold or(liven to the pupllc: Alternate: <br /> ke-K,tk- foil <br /> d. 1 am providing food that is NOT prepared at home:❑Yes❑No <br /> All food is prepared on-site or is from approved commercial fsdlilies: es❑No <br /> Namo of facility: als-7- ' T"ey,/,& C,k Phone:L_ <br /> Address of facility: .Gr ZV C * 5 <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 /> 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 /> G. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ll�pproved 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 booth's use: es❑ No <br /> 8, 1 am providing an accurate probe thermomele o measure the hot and cold holding of potentially hazardous <br /> _ <br /> foods during ail 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 /> t35° <br /> B'Camp stove ®4rno&hotel trays <br /> Ng-double steamer ❑Steam table&fids <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(fairy products. <br /> 1868 E. Hazolton Avenue Ii Stockton.California 952051 T 209 468.3420 1 F 209 461-0138 I www.sjgov,orglehd <br /> EHD 16.02 Pape 7 of 11 TEMP LVEN1 APP <br /> 06/10119 <br />