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S A N D aA Q U I N 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. r7 <br /> 1. 1.Name of Event: ` �+ ���:C�C�� �y � __ Date(s): 9 O► <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: ` � <br /> 1 <br /> Address: " s � <br /> Phone: ( ��� ) �-� � � -- Alternate: ( byl '6 14 - 0 <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: [ Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes ❑ No <br /> Name of facility c ' i one: <br /> Address of facility: �1 L "� � <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 /> I 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 /> ❑ 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 wW be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> n-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7 Electricity is provided for my booth's use: es ❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: 2es ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ Double steamer team table& lids <br /> ❑ Electric stove top ❑ Other(specify) <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 I F 209 464-4138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 0612812023 <br />