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REC-008 <br /> t � <br /> S A N .j 0 A U IN Environmental Health Department <br /> —C UNTY <br /> �•il,l,,;,, " (.�rr,a[rt<'Sti crows ftr.fC. <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. 1.Name of Event: Music in the Date(s): t7 <br /> 2. The fallowing is information about my organ izalion/busi ness: 1. <br /> Name of organ ization/business: k � <br /> Address: G �� _ 1r,LC1� l,OP Ll Qf?� <br /> Phone: 9 1,2_9 Alternate: >n " 27 b <br /> 1� <br /> 3. List food to be sold or given to the public: 't�j C�i A t� •;Ay4 CQm yq� t �TeAT(6 yNs' lvc. <br /> 4. 1 am providing food that is NOT prepared at home:DesKk <br /> All food is prepared on-site or is from approved commercial facilities:�'es�lo <br /> Name of facility: Phone: <br /> Address of facility: <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 walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> scar ening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean carps 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 /> �n-site hose bib that is connected to a potable water source. <br /> 7. Pher(specify): <br /> eoldoity is provided for my booth's use Ye No <br /> 8. 1 am providing an accurate probe the r asure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation Ye 0 <br /> 9. 1 am providing the following hot lemperatu e contro o the hot holding of all potentially hazardous foods above <br /> 50F: <br /> amp stove Slerno& hotel trays <br /> ouble 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 /> 1866 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 E 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16,02 Page 7 of 11 TEMP EVENT AP <br /> 06119/19 <br />