Laserfiche WebLink
Environrr ntal Health Departmen <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1 <br />2 <br />Phone:) <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />( 0-C^) <br />List food to be sold <br />SAN JOAO"'N <br />- C O U N * V <br />________ Alternate. ( <br />or given to the public: <br /> On-site hose bib that is connected to a potable water source. <br />S Other (specify): . "V f aaU - Qj s c-„ ' C -? t - A' o <br />Electricity is provided for my booth’s use: Yes No v v ---------------------------- <br />1 ism ho‘and ”w <br />I am^roviding the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer g| steam toblB 4 Ms <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food Include- <br />vegetables, potato salad, eggs, and dairy products. <br />Note: whfch <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />Haze,ton Avenje I Stockton, California 95205 | T 209 468-34201 F 209464-0138 I www.sicehd corn <br />Ail 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 f3) weeks prior to this event. / / <br />l—L Date(s <br />The following is information about my organization/business: <br />Name of organization/business t/YgAT a 5^ <br />Address: _ <^5^ C_r gzji< V r a-W, <br />ST,") <br />I am providing food that is NOT prepared at home. Fyl Yes f~~l No <br />A.I food is prepared on-site or is from approved commercial facilities. O Yes | 1 No <br />Name of facility _phone: ( } <br />Address of facility ________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />O A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />Xs^om toe X aCCePtab'e’ and const™ted separate food and food preparation <br />EJ Other (specify):