Laserfiche WebLink
--t�7_ I o+ _'� <br /> SANJOAQUIN <br /> Environmental Health Department <br /> co, NTY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> of this checklist to <br /> All food vendors (both for profit and non-profit) <br /> are this evented to return a signed and completed copy , <br /> the festival coordinator three(3)week p 5-T (ze e-T F A I R <br /> r- a Date(s):10-5 4- Cv-lo; 2021 <br /> 1. 1.Name of Event: <br /> V .• rr. <br /> 2. The following is information about my organizabonibusiness: _ I <br /> Name of organization/business: <br /> Address: <br /> Phone: <br /> J _! Alt <br /> (Z�') G COC � <br /> 3_ Lisi food io be said or given io i'ne public: �, 8 r m t 1 Q l�5 <br /> 4 1 am providing food that is NOT prepared at home: Wo eS 0 No <br /> 1es. /s❑ No <br /> All food is prepared on-site or is from approved phone. <br /> Name of facility: <br /> Address of facility: d fcod anal foo j-preparation arcets from fl,es, <br /> n� h.. yl.., 'ah h tc..o+%•'+ (tag Protect my tln��nCa�e <br /> I qli' iJrV viull,g U V,00+ Y�Itt! Ltle IV1ttl YY 111g <br /> dust and the public) <br /> L!�bo� lar material and fine mesh fly <br /> oth with walls and ceiling constructed of either wood,so have alsmooth and cleanable floor (concret <br /> screening, completely enclosing open food areas. it preparation <br /> 9 <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br /> areas fron, Uhu public. <br /> ❑ Other(specify): <br /> Note: The only operations not required to foods close approved sources. <br /> are <br /> . those which sell beverages from <br /> approved dispensers, or prepackaged provide <br /> from <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> 1 <br /> Other(specify):-Or) bb wr Int, I <br /> 7. Electricity is provided for my ooth's use: 'Yes❑ No <br /> 8. i am providing an accurate; probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:w'es❑ No <br /> 9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Stemo&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top Vether(specify) Y1 eQ:L P 5 <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06119,'t <br />