Laserfiche WebLink
SAN JOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY <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. Name of Event: 7h/4 nat Date(s): 5—/2 <br />The following is information about my organization/business: <br />Name of organization/business: 7.; 4 vo-d 74—e4e2.1 <br />Address: 444','orf Ae j (1//- z_ <br />Phone: (/f) (i-e4 -7--'3 Alternate: ( <br />/72e .ceest-n_ <br />List food to be sold or given to the public: 3,/i/eizh' (%5-tt tt/ 11/4 /.7)4.f kj/efet r ,16f,‘-tia <br />I am providing food that is NOT prepared at home: 17(Yes El No <br />All food is prepared on-site or is from approved commercial facilities: IZI7Yes 111 No <br />Name of facility: A- a. Phone: j:711fi ) .5;109,— 73-g 5/ <br />Address of facility: ol I/SY /‘,47/}-Z, At_{S LIne; 115702// <br />I am providing a booth with the following: (to protect my unpacka6ed food and food-preparation areas from flies, <br />dust and the public) <br />El/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. 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 />D/Other (specify): 7561 Lt. <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />El Approved bottled water. <br />El On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's use: lErYes 111 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: jaYes n No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />111 Camp stove 111Sterno & hotel trays <br />El Double steamer ErSteam table & lids <br />El Electric stove top n Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue! Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/19/19