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' REC-008 <br /> -orununtai Health Department <br /> —COUNTY <br /> --- <br /> Oroutness grows hero, i <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> t <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist 10 ! <br /> the festival coordinator three(3)weeks prior to this event. i <br /> Juneteenth 4 of Jul <br /> 1. 1.Name of Event: Kite Festiv� Y M1P Jul, Aug pate(s): 6/1 6/15 7/4 7/20 <br /> i <br /> Cultural Celebratlo Light Up Main Street 8/17 9/21 12/6 <br /> 2. The following is information about my organzation/business: i <br /> Name of organization/business: ~ �-� SU R Q'e e- 1 VMk3 i L Q C 0P T U C, <br /> Address: E H 1dial WP�l /N j'5 WC K`tWrJ ` C 0 9 75 Z 15 <br /> Phone: 5 1 o r05U T Alternate: <br /> 3. List food to be sold or given to the public: (),AZi(-( tJl <br /> 4. 1 am providing food that is NOT prepared at home:P 16s 0 <br /> All food is prepared on-site or Is from approved commercial facilities:76[7bo <br /> Name of facility: q(R 1rvv()r-A Lk C'(ale_:r Phone: �w sU _ <br /> Address of facility: � fr\4 <br /> 5. 1 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 wails and ceiling constructed of either wood, canvas, plastic, similar material and tine mesh fly <br /> ening, 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 /> ®Approved bottled water. <br /> Dn-site hose bib that is connected to a potable water source. <br /> Peotricity <br /> ther(specify): <br /> 7. is provided for my booth's usftYeNo <br /> 8. 1 am providing an accurate probe thesure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operao <br /> 9. 1 am providing the following hot tempethe hot holding of all potentially hazardous foods above <br /> 5°F: <br /> p stove tbrno& hotel trays <br /> ble steamer Steam table & lids <br /> lectric 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 /> 1868 E.Hazelton Avenue I Stockton,California 952051 T 209 468-3420 1 1= 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16.02 Page 7 of 11 TEMP EVENT APP <br /> OB119119 <br />