Laserfiche WebLink
TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): .S. <br />Page 5 of 6 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />checklist to the festival coordinator three (3) weeks prior to this event. <br />onfbusiness: <br />lf>\ <br />[ ] Electric stove top <br />['^Other (specify): // <br />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 <br />methods: <br />['XSApproved bottled water. <br />[vg 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: [vf'Yes [ ] No <br />8. lam providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all time of booth operation: [./Yes [ ] No <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />above 135 degrees Fahrenheit: <br />f/f Camp Stove [ ] Double steamer <br />[/f Stemo & hotel trays Steam table & lids <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice vegetables, <br />potato salad, eggs and dairy products. <br />/Xj SAN JOAQUIN COUNTY <br />ENVIORMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />Business: (209) 468-3420 <br />1. Name of Event: <br />2. The following is information about my organizatio: <br />Name of organization/business: <br />Address: <br />Phone: 7^^ Y Alternate: IT- I <br />3. List food to be sold or given to the public: , g g Sl <br />k, -r'e <br />4. I am providing food that is NOT prepared at home: [x/Yes [ ] No <br />All food is prepared on-site or is from approved commercial facilities: [/] Yes [ ] No <br />Name of facility: t t- Phone: f <br />Address of facility: t <br />5. lam providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />f-XA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />[v/(Dther (specify): <br />Note: