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R EC-008 <br /> S Q N J n A Q U I N Environmental Health Department <br /> —COUNTY <br /> Csrcritnrass moves floe, I <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 /> Kite FestivId Juneteenth 4 of July MIP Jul, Aug 611 6/15 7/4 7/20 <br /> 1. 1.Name of Event: Date(s): i <br /> Cultur 1 Celebration Light Li Main Street 8117 9/21 12/6 ' <br /> 2. The following Is Inlormalion about my organlzatlon/busines : <br /> Name of organ Izatlonlbusiness: �— `-' '2) _C�l0 eeL I 'C103}Le- CII(WIT Lk- G <br /> Address. �� E Em WPl 1 4LOC K ItQIJ t_ C for 752-1 tj ' <br /> Phone: 510 050 }} Alternate: <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:Ekes1l,0 <br /> All food is prepared on-site or is from approved commercial iacililfes:®Yes�Va <br /> Name of facility: ql? —Phone: S 1 ) �U <br /> Address of facility: � tC9+RW 1�4 <br /> 5, 1 am providing a booth with 1he following: (to protect my unpackaged food and food-preparation areas from [ties, <br /> dust and the public) <br /> 3 booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> erring, 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 /> Dther(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 /> E�]Rpproved bottled water. <br /> ❑Jn•site hose bib that is connected 10 a potable water source. <br /> 7. Pther(specify): <br /> e,�Jricity is provided for my booth's use Ye No <br /> B. I am providing an accurate probe the asure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation Ye o <br /> 9. 1 am providing the following hot temperate c nir the hot holding of all potentially hazardous foods above <br /> 5°F: <br /> p stove Brno& hotel trays <br /> steamer Steam table &lids <br /> ]�oble <br /> 'trio stove top Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1869 I=, Hazellon Avenue j Stockton, Californla 952051 T 209 468-3420 1 t- 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16.02 Page 7 of 11 TEMP EVENT APP <br /> 081 f 9119 <br />