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?• ' • SAN. JOAQUIN CO&TY <br /> ion ENVIORMENTAL HEALTE-DEPARTMENT <br /> 'tot - ;_; 18a Feat Numb=AveSaG Stodctoo,Calffornin 9SM <br /> ' D amass: (20)4f8-3420 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vt rs(both for profit and non-profit)are required to return a signed and completed copy of this <br /> c>yO�the festival ccordivator throe(3)weeim prior to this event. <br /> 1. Name of Event: % ram C �s�°� �f• y,�7 I7ate(s): z- <br /> 2. The following is information about my organixatiowbusiness: r <br /> Name of 'on/business: •� .�.1 .� <br /> Address: d, 160 <br /> Phone: p 2 --4E4ME Alternate: 0T3--l 'C 7t3 <br /> 3. List food to be sold or given to the public: 40ML45A <br /> 4. I am providing food that is NOT properW at home: [0q Yes [ ]NO <br /> All food is pared on site or is from appro commercial facilities: [, Yes [ ]No <br /> Name of filiiy: Phone: � 7.Z 7-�-5"�"�CIL <br /> Addrea of facility: S <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation anus from <br /> flies,dust and She public) <br /> A booth with,walls-and ceiling con$t►vcted of-either snood,canvass plastic,similar material and fine <br /> mAh fly scram,completely enclosing open food areas. It will also have a smooth and cleanable floor <br /> (concrete,asphalt,clean tarps and smooth wood are acceptable)and co=tnicted to separate food and food <br /> }reparation areas from the public. <br /> [ ]Odi ar( fy)� <br /> Note.- The only operations not required to provide endosed 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 <br /> - methods: <br /> bQ Approved bottled water. <br /> Or site-how bib that-is comiected-to a potable water wu=. <br /> [ ] Other( '): <br /> 7. Electricity is provided for my booth's use: ]Yes [ ]No <br /> 8. I am providing an acc umte probe therwometor to the lot and cold holding of potentially hazardous <br /> foods during all time of booth operation: [MY es [ ]No <br /> 9. I am providing the following}tot tempe�ue for the-hot}holding of all Pally bazardous foods <br /> above 135 degrees Febreanheit: <br /> Camp Stove [ Double steamer [ ]Electric stove top <br /> [ ] Steam dt hotel trays [ ]Steam table&lids [ ] Other(specify): <br /> Notes VXampks of wally hazardous food inrhude:meaft,tomes,cooked beans,rice vegetables, <br /> eggs and dairy prod,� <br />