Laserfiche WebLink
SAN JOAQUIN <br />—Gou t' <br /> <br />Environmental Health Departrnet IL <br /> <br />TEMPORARY FOOD VENDORS APPLICATION <br />All food vendors (both for profit and non-prof) are required to return a signed anc iitpleted copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event \ A-L r Date(s): <br />The following is information about y organization/business. <br />Name of organization/business: <br />) <br />List food to be sold or given to the public:ACCV.AA7i 5 1— On 2Q-114" <br />I am providing food that is NOT prepared at home: lilies 0 No <br />All food is prepared on-site or is from approved commercial facilities YesEl No <br />Name of facility: Cl C I A g tr,3) Phone: <br />Address of facility: cis \,\ irt fr-kt L-/€ <br />( ) <br />I am providing a booth with the folloiving: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />CrS...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 (corcrete, <br />asphalt. clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0 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 followino methods' <br />EI-A-Pproved bottled water <br />0 On-site hose bib that is connected to a potable water source <br />U Other (specify): <br />7 Electricity is provided for my booth's use: 0 Yes-11-413 <br />8 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: v_zys E No <br />9 I am providing the following hot temperature control for the hot ho:ding of all potentially hazardous foods above <br />135'F: <br />Eirerm-p stove ...:greterno & hotel trays <br />0 Double steamer `-t!..I.Sfearn table & lids <br />F.2 Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked <br />beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. I- • r.,imr,rniti 952051 T 209 468-3420 1 F 209 464.0138 1 www s-Kry,olgiend <br />EPIC, 16-02 <br />Pow. of 11 <br />TEMP EVENT' APP <br />0619,2021 <br />LLC <br />Address: WA A4_ <br />Phone: (CZT 2O — Alternate