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rh V�F"t"'4 <br /> 0 <br /> AIC <br /> 1"EfYIPORARY €-000 VENDOR'S APPLICATION <br /> At food vendors(both for profit and non-profit)are required to return a signed and completed Lx3py of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 9. I.Name of Event:-- Dalu(s). <br /> 2, The following is information about my organization/business: <br /> Name of <br /> <br /> <br /> <br /> Phone: Alternate: <br /> e <br /> 3. List food to be sold or given to the public., Vl'-�4 <br /> 4. 1 am providing food that is NOT prepared at home:0 Yes❑No <br /> All food is prepared ort-sftc or is from approved commercial facilities:0Yes[:1 No <br /> Namooffacility. -Phone: _5t <br /> Address of facility: 'X 14bC-Zi4: !.-�T­ <br /> 5. 1 am providing a booth with the following:(to protect m�unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A 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 /> El 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 /> El Approved bottled water. <br /> El On-site hose bib that is connected ton po4ible water source. <br /> 0 Other(specify): <br /> Y. Electricity is provided for my booth's use:[]Yes F]No <br /> %I'A 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all limes of booth operation:[D Yes F-1 No <br /> 9. 1 am providing thn following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> EJ Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer E]Steam table&lids <br /> ❑Electric stove top f-1 Other(specify) <br /> Note: Examples of potentially hazardous food include-. meats, tamales, cooped beans, rice, <br /> vegetables,potato salad,eggs,and dairy product--.. <br /> 1868 E.Ha7elion Avenue I Stockton, California 95205 1 T 209 468-3420( F 209 464-0138 1 Y,,ww.sjgov.org/ehd' <br /> C-110 ib02 TEMP EMFNT APP <br />