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Address: <br />Name of organization/business: <br />(67143 ) 5 Phone: <br />Z-01(dici Ltc_ <br />Alternate: ( <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br /> <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. 1.Name of Event 771/G 52/7 /(5 7/1.hS <br />2 The following is information about my organization/business: <br />Date(s ). <br />List food to be said or given to the public: 41 <br />I am providing food that is NOT prepared at home: EXes El No <br />All food is prepared on-site or is from approved commercial facilities: 1Yes El No <br />Name of facility: 24 kitu1c-ps Phone:I <br />, - <br />Address of facility: 2Z5 iviudisuo )91,,e j Zakcs <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 />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. ft 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). <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 />6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />ES/Approved bottled water. <br />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: ffeYes 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: 'Yes 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 />Camp stove E6terno & hotel trays <br />Double steamer [team table & lids <br />Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />i ; 'Zi A C.'i u., 91) 2 j T 4613-3420 I F 209 464-0138 www.sjgov.org.ehd <br />1o.J2 Vega Of i 1 TEMP EVENT AP P <br />06)19119