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� • wIH . I <br /> 'P=c%' SWJ a A Q U I N Environmental Health Department <br /> JUQO� —COUNTY— <br /> { r Greatness grows t <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: . Ce_-y,;_I_>vet-vtcv! Date(s): 0 0 r <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organization/business: U;f• Svc 1 c S`r v�c_ <br /> Address: Ul w <br /> Phone: (r,;; ) O'Z 14 r-, Alternate:{ } <br /> 3. List food to be sold or given to the public: <br /> 4- I am providing food that is NOT prepared at home: Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities:Yes ❑ No <br /> Name of facility: `>>4�c k • t - �, � C', Phone' <br /> Address of facility: ,Z s C C, f -r i, - t V, ; k <br /> 5 1 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 wails 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 /> jj 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 /> gApproved bottled water. <br /> e <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes: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:E�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 /> ❑ Camp stove ❑ Stemo& hotel trays <br /> ❑Double steamer ❑ Steam table& lids <br /> ❑ 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 /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 j F 209 464-0138 1 www.sjgov.orglehd <br /> EHD 1"2 Page 7 or 11 TEMP EVENT APP <br /> Q6f2972023 <br />