Laserfiche WebLink
<br />4/27123, 8:20 PM 79F37D78-C686-454E-96E3-425099743129.jpeg <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COUNT' <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 /> <br />1. 1.Name of Event: ( TC060-V--- Date(s): .0 11 1 <br />The following is information about my organization/business: <br />Name of nrgaoi,-ati^n/business: C p eft R7,-) <br />Address: I ) 4 e2-00 le- D L L NiE.12-014-E -C/1-6/4cYj <br />Phone: ( 6 )2 ) Alternate: (6 22-) 6 biz, <br />List food to be sold or given to the public: C \ C lc-Jr Ps- (2-tCa c_r•-&-)C-LAPP/ <br />I am providing food that is NOT prepared at home: 11:14s 0 No <br />All food is prepared on-site or is from approved commercial facilities: Ercles No <br />Name of facIlItY: ,(2-11W-1- Phone: )— 6 2i3 <br />Address of facility: r.-4-(.2 O )‘-14----t P O gfIrcbr,,EA-- <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 />0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and tine mesh fly <br />screening, completelygoelosfrigopeeJgod areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps, Ad smooth wood ar eptable) and constructed to separate food and food preparation <br />areas from the pu <br />Ether (specify f: <br />Note: The The only oeatklns not reqeirJD.provide enclosed booths are those which sell beverages from <br />approved dispens'0rpr8Tlaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />D Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use: D Yes 0-No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: lac'es 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135'F: <br />0 Camp stove 0 Sterno & hotel trays <br />D Double steamer 2:glearn table & lids <br />D 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 />Z[161. fl l..c AsT t:JC k'0 I. t io T 7:J1468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />D1,.-e2 Page /oft , TEMP EvENT APP 06/19/19