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SAN JOAQUIN <br />—COUNTY— <br />Environmental Health Department <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: -kr( c. Li 'Vizi& "All Tulttiiier 1\6 eventate(s): ID — 12) -iJ <br />The following is information about my organization/business: <br />Name of organization/business: \-) 111' 5 N1141 tn <br />Address: Ut‘ le2 ) I Eatl CVA-- C-19.M <br />Phone: 29 -(6 II Attemate: (.20) 5d1 = -102- <br />List food to be sold or given to the public: lilt 611 e-e-, <br />I am providing food that is NOT prepared at home: ED Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 6A Yes 0 No <br />Name of facility: Phone: f ) <br />Address of facility: <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 />D 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 />Other (specify): Rail eK <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 />Approved bottled water. <br />E] On-site hose bib that is connected to a potable water source. <br />I RACt e.ottlrav-.1-mc(d Other (specify): <br />Electricity is provided for my booth's use: 0 Yes D 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 />0 Camp stove <br />0 Double steamer <br />ID Electric stove top <br />fl Stemo & hotel trays <br />Steam table & lids <br />O Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />..•••••••in 1" I_ _It . • <br /> <br />n n nnn an • n•nn I <br />