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S A N J 0 A O U II N Environmental Health Department <br /> -COUNTY--. <br /> v:c'U iteSI i{ vvyro 17er <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. 1.Name of Event: ` ` Date(s): '� <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: <br /> Address: .. : r <br /> Phone: Alternate: <br /> 3. List food to be sold or given to the public: <br /> 4. i am providing food that is NOT prepared at home: EI`Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: El Yes ❑ No <br /> Name of facility: Phone: <br /> Address of facility: <br /> 5- l am providing a booth with the wing: (to protect m unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> LI 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. tt 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 /> Q 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. ,A�pppr�oved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> U Approved bottled water. <br /> FO-site hose bib that is connected to a potable water source. <br /> ©Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes❑ 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: ❑ Yes❑ 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 /> Rtamp stove M stemo&hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top [EYbther(specify) c4yj <br /> rA <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br /> EHQ 16-02 Page 7 of 11 TEMP EVENT APP <br /> 0713/17 <br />