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J ' <br /> RFC-008 <br /> SAN . JOAQUIN 12nv�rronnu ate- Heahli Department <br /> —COUNTY— <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> I <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 /> Music in the/w a� <br /> 1. 1.Name of Event: Qate(s): .,/bet - y <br /> 2. The following Is Information about my organ Ization/buslness: <br /> Name of organizatlon/bus�lness: <br /> Address: iVd a 1&33 l <br /> Phone: _ �_� 7 b 4 Af1tternale: 1 �� �u o 3 19 <br /> 3. List food to be sold or given to the public: . o <br /> 4. 1 am providing food that Is NOT prepared at home: L-S13a ) <br /> All fond 1s prepared. sllef ris Irom approved commercial facilltles:Ef z to <br /> Name of facility: Phone: <br /> Address of facllity: � 1-rIAN_e�f ��k/.�+v'U_L - /6dl - - - - <br /> 5. I am providing a booth with the (lowing: (to protect my unpackaged food and food-preparatlon areas from files, <br /> dust and the public) <br /> booth with walls and ceiling constructed of either wood, canvas,plastic,similar material and line mesh fly <br /> erring, cornpielely enclosing open food areas. It will also have a smooch and cleanable floor (ooncrete, <br /> asphalt, clean carps and smooth wood are acceptable) and constructed to separate food and lood preparation <br /> areas from the public. I <br /> Diner(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 lollowing methods: <br /> ❑Approved bottled water. <br /> F]Dn-slte hose bib that Is connected to a potable water source. <br /> WeIrthicily <br /> er(specify):44�W�fnl 00P <br /> 7. Is provided for my booth's Use a hfc <br /> 8. 1 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 temperatu ntr the hat holding of all potentially hazardous foods above <br /> 5°F: <br /> amp stove 401i'harrno& hotel frays <br /> cubic steamer eamtable&lids <br /> lactrio slave top (specify) <br /> Hale: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato$clad,Vggs,and dairy pr9ovOe. <br /> IB63 E. tlazelton Avenue I Stockton,California 952051 T 209 468-3420 1 1= 209 464-0138 1 www.sjgov.org/etid <br /> EHr3 mw Pago 70111 TEMP EVENT APP <br /> aansris <br /> y <br />