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REC-008 <br /> SAN ,JOA UIN Erivirionmell.dal Health [department <br /> —COUNTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-prolil) are required to return a signed and completed copy of this checklist to f <br /> the festival coordinator three(3)weeks prior to this event. <br /> Kite FestivR Jurneteenth 4 of July MIP Jul, Aug 6/1 6/15 7/4 7120 i <br /> t.Name of Event:_ Date(s): <br /> Cultural Celebrallor� lght Up Main Street 8117 9/21 1216 <br /> 2. The following Is Information about my organlzatfon usiness: <br /> Name of organlzation/buslness: 'NAa-' h U R�►U �- ! S}tiot311J G��� LL G <br /> Address: {1 1 ( Z G 4WC K ILO V J <br /> Phone: 5 i Q 050 M T+ Alternate: <br /> 3. List food to be sold or given to the public: B R A-Li Lj Rtj iywb <br /> 4. 1 am providing food that is NOT prepared at homer 1 es[140 <br /> All loud is prepared on-site or is from approved commercial facilities:®Yes[jJo <br /> Name of facility: q(R IWO 611k C, Phone: S(0 (056 <br /> Address of facility: RW ft'-/ <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, plas1lc, similar material and line 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 acceptabie) and constructed to separate food and food preparation <br /> areas from the public. <br /> �Jlhor{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 wale(. <br /> 13n-site hose bib that is connected to a potable water source. <br /> 7. Pther(specify): <br /> ectricity is provided for my booth's use Ye No <br /> B. 1 am providing an accurate probe the asure the hot and cold holding of polentially hazardous ' <br /> foods during all times of booth operation Ye o <br /> 9. I am providing the following hot temperate ontr the hot holding of all potentially hazardous foods above <br /> p stove tbrno& hotel trays <br /> steamer Sieam table & yids <br /> J�uble <br /> ctric stove top Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dalry products. <br /> 1868 E. Nazelton Avenue I Stockton,California 062051 T 209 468-3420 1 F 209 464.0138 1 www.sjgov.org/ehd <br /> E14D 15.02 Pago 7 of 11 TEMP EVENT APP <br /> 46t1911S <br />