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SANAAQUIN <br /> <br />Environmental Health Department <br />COUNTY— <br />Greatness grows here <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br />, <br />. Name of Event: 14-11Li- -1/LS2 Va.,( <br />completed copy of this checklist to <br />Date(s): i <br />The following is information about my organization/business: <br />Name of organization/business: ReCk.,..-6 L C FtidAQ.-til., <br />I <br />Address: 4-(01-NY jt((JiA Li <br />C () <br />List food to be sold or given to the public: g(X_i-/-1/1"-eek /%1A06A1ht CLILS <br />I am providing food that is NOT prepared at home Z Yes 1=1 No <br />All food is prepared on-sit or is from approved omm rcial facilities: lYes D No <br />Name of facility: I A gd ( Phone: <br />Address of facility: 1/' ( 3 F,) J< 'Y? q, 01- Q52- b <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. 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): <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 />0Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />D Other (specify): <br />Electricity is provided for my booth's usel Yes CI 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:10AI 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 Lii Sterno & hotel trays <br />Double steamer 0 Steam table & lids <br />0 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 />1868 E. Hazelton Avenue Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />END 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />Phone: Alternate: (