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SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY— <br />-c-.1111.11.01e.'1" <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: Date(s) olbolzq <br />2. The following is information about my organization/business: <br />fl <br />Name of organization/business: SAN\ <br />Address: f401 Dcw_ <br />Phone: ( 1)001 ) Q1 --I -1 _ Alternate: ( ) <br />3. List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes E) No <br />All food is prepared on-site or is from approved commercial facilities: Yes El No <br />Name of facility: 1---0/ Grip( Phone: ( Y-0/) 30q -0277 <br />Address of facility: lig LOdt-itr, tbr-I.1 CA 6:15-*P <br />AA) 'Aktg Ot-U CIAA4.0-4Afx- <br />cva- zkonA04-.4is <br />5. 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 />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 />N/Approved bottled water. <br />E] On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's use: EZ/Yes E No <br />I am providing an accurate probe thermomr to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: [4 Yes E No <br />9 I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135"F: <br />LI Camp stove R(Sterno & hotel trays <br />El Double steamer LI Steam table & lids( <br />Electric stove top El 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 I F 209 464-0138 I www.sigov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023