Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />of livcnl.1. <br />2. <br />Address- <br />)_____ Phono: <br />3. <br />4. <br />!>. <br />G. <br />9 <br />inoals, tamales, cooked beans, rice,Note: Examples of j>otentially hazardous food Includo: <br />vegetables, potato salad, eggs, and dairy products. <br />•z <br />I. <br />H. <br />SAN JOAQUIN <br />( (HIN I Y <br />All food vendors (both for profit and non-profit) arc required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />l.ODI GRAPH FESTIVAL _Dato(s);SE!2l-1L.?0” <br />I am providing food that is NOT prepared al homo:Yes [J No <br />All food is prepared on-site or is from approved commercial facilities:^ Yes |_J No <br />Name of facility:Phono: (-------)------------------------------------ <br />Address of facihty:._ -. -- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br />[ I A booth with walls and coiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. Il will also have a smooth and cleanablc 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 />^4 Other (specify)-... / I .(C. ------- ---------- -------------------- ------------- ——------ <br />Note: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved waler for drinking, utensil and hand washing will bo provided in my booth by the following methods: <br />C.ilifmniii I T 209'IGli 3420 | F 209 4(i<l 0I3B | www.-.jcehd com <br />i-.,,.. , <* H tiMiuvim ait <br />| | Approved bottled water. <br />^4 On-site hose bib lhat is connected to a potable water source. <br />[ | Other (specify):--------- ---------------- ------- --------------------- ---------------- ---------- <br />I loctiicily is provided for my booth's use: M Yes I I No <br />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: U Yes | J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135-F: <br />[ | Camp stove I I Stcrno & hotel trays <br />| 11 )oul>lo steamer I I Steam table & lids <br />| 11 lectiic stove top [ I Other (specify) <br />I he following is information about my organizalion/buslness: <br />Name of organizalion/buslness: <br />Alternate: ( <br />I ist food to lie sold or given to the public:. ,-^5 <br />I1 Ui I I la/ellon Avcfiue |