Laserfiche WebLink
4/24/23,8:54 AM image2.jpeg <br /> u N J U A IN tnvironmenLai Health Department <br /> COUNTY..... ._ <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 /> Date(s) b T� f✓ -,� <br /> 1. 1.Name of Event: �--�- <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: F (e,Yo 2 rJ`-'J "�r <br /> Address: 6( Z R L 1 e-V41C y k �2_° &1`— <br /> Phone: ( G1(v) 5-`��1' -46-, c 1 Alternate: ( ) <br /> 3. List food to be sold or given to the public: , ��%� ° �CaA S t Q-a <br /> 4. 1 am providing food that is NOT prepared at home: ❑Yes(Slo <br /> All food is prepared on-site or is from approved commercial facilities:,0Yes❑ No <br /> Name of facility: Phone: l ) <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 /> booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> Greening, 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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> E�A7pproved 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: 5wes ❑ No <br /> 8. 1 am providing an accurate probe thermofneter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:%RrYes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods abov( <br /> 135T. <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ D uble steamer ❑ Steam table& lids <br /> Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, ric <br /> vegetables, potato salad, eggs, and dairy products. <br /> T 209 468-3420 1 F 209 464-0138 1 www.sigov. rg/e <br /> 1868 E Hazelton Avenue I Stockton, California 95205agI 7 of 11 <br /> EVEN <br /> 7K) 16-02 <br /> https://mail.google.com/mail/u/o/?tab=rm&oabl#inbox/KtbxLriNcfTMSLCiKxQSPBciVfvnN.]XvVIIR?nrniartnr_l /1 <br />