Laserfiche WebLink
DocuSign Envelope ID A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />R EC-008 <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 />musi c at the park Kite Festival Juneteenth 4th of July <br />1.Name of Event: Date(s): <br />Address: 99 w brilloso lane <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY — <br />Greatness 9rows here <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />5-18-24 6-1-24 <br />b-15-24 <br />2. The following is information about my organization/business: 7-4-24 <br />.Carter six <br />Name of organization/business: <br />Phone: <br />6192448618 6195607343 churros, mini pancOes <br />funnel erriate. cakes, tt <br /> <br />candy, Mexican candy, <br />List food to be sold or given to the public501 t e r hnnuelng <br />I am providing food that is NOT prepared at home: Yes E No <br />All food is prepared on-s8r(ireip fiFx-1 approved commercial facilities: E Yest No <br />Name of facility: Phone: <br />99 a brilloso <br />Address of facility: -lane, mountain <br />I am providing a booth with the folloVvillcyc(to protettqyrty 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. 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 />El Other (specify): `::;73 (1z) c)--Qi{C\ C <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 />On-site hose bib that is connected to a potable water source. <br />111 Other (specify): Food warmers <br />Electricity is provided for my booth's use: E Yes E 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: E Yes E No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />E Camp stove E Sterno & hotel trays <br />E Double steamer E Steam table & lids <br />;1 Electric stove top xE 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 95205 I T 209 468-3420 F 209 464-0138 i www.sjgov.orgiehd <br />END 16-02 Page 7 of 11 TEMP EVENT APP <br />06119119