Laserfiche WebLink
S A N -,JOAO U IN Environmental Health 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 Name of Event- Date(s) <br /> 2 The following is information about My organization/business: <br /> Name of organization/business. jQi4L' e!)(��Logj <br /> Address: M. <br /> Phone <br /> Alternate. -7� <br /> 3 List food to be sold or given to the public: FYiCo64), (11 j(_ram 1-c 0_� <br /> 4 1 am providing food that is NOT prepared at home ( es F1 No <br /> All food is prepared on-site or is from approved commercial facilities: 9 es ❑ No <br /> Name of facility. Phone: <br /> Address of facility. <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 /> L9`�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 /> 0 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 /> (Approved bottled water. <br /> 0 On-site hose bib that is connected to a potable water Source. <br /> 0 Other (specify) <br /> 7 Electricity is provided for my booth's use: 0 <br /> 6. 1 am providing an accurate probe theri-norneter, to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation, t��s [-- <br /> I No <br /> 9 1 am providing the following hot temperature. control for the hot holding of all potentially hazardous foods above <br /> 135'F <br /> ["] carrip stove ❑ Sterno & hotel trays <br /> (—bouble steamer 0 Steam table & lids <br /> Cj Electric stove top 0 Other(.specify) <br /> Note., Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> I"- HiAzelton A, ,:5nue I Stockton, Calirotriia 95205 1 T 209 466-3420 1 F 209 4C)4Aj 138 1 wvv,,v S1:cei'.d cc,�tn <br /> FWJ0 I of I$ <br /> ;�: <br />