Laserfiche WebLink
FROM FAX NO. an. 2-0 2013 1::36PM P5 <br /> Yl <br /> Environmental Health Department <br /> ? SAW]OAQUIN <br /> 0 U N T Y-- <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 thre (3)weeks prior to this event 46 -7 <br /> 1 1.Name of I I Date(s)' <br /> 2. The following is information about my organization/business: <br /> --BName of organization/business: i4ZS <br /> Address: <br /> Phone. Alternate: <br /> 3. List food to be sold or given to the public. i I i C41 fffV- I WD d4sI CA461 <br /> M ox S�� W_ rs, sin,owo_ <br /> 4. 1 am providing food that is"01 prepared at home: EAYes F1 No <br /> All food is prepared -site or is from approved commercial faqitos: Yes F1 No <br /> Name offacility: L_tZ71 a4an Lle�0�-10" <br /> -��-M 1, , I Add <br /> Address of facility: ItAb <br /> 5. 1 am providing a booth with the . (to protect my'Unpa6kaged food and food-preparation areas from flies, <br /> dust and the public) <br /> XA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mash 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 /> [I Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or pnNxH*aged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> )�Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify)- 'M <br /> 7, Electricity is provided for my booth's use: Yes n 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:ki 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 /> [I Camp stove D Sterno&hotel trays <br /> Lj Double steamer Steam table&lids <br /> [] Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food bwalude: meats, tamales, cooked beans, rice, <br /> vegetables,potato Salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton California Ar'905 I T 209 468-3420 1 F 209 464-0138 1 www-sjcehd.com <br /> Received Tirrie Mar, 14, 2019 2 : 3 9 PM No, 4 7 9 7P."-i f ii TEW EVENT APP <br /> Ut/W1( <br />