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df <br /> I <br /> R EC-008 <br /> SAN. JOAQUIN Environmental Health Department <br /> , ti <br /> ! 1a,f...:,• —C®UNTY— <br /> I Greotn, •.s vow. h rv, <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> AI[ food vendors (both for profit and non-proilt) are required to return a signed and completed copy of this checidist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> f. 1,Narne of Event - AALP V Date(s): . <br /> 2. The following Is information about my organ!zallon/business: <br /> Name of organization/business: RAYS FLAVOR OF INDIA <br /> Address: <br /> 71 CHARLES ST TRACY CA 95376 <br /> Phone: 408-821-6108 Alternate: 209-362-669D <br /> i <br /> 3. List food to be sold or given to the public: INDIAN STREET FOOD AND DRINKS i <br /> 4. 1 am providing food that is NOT prepared at home:Fv_�es[lo <br /> All food is prepared on-site or is from approved commercial faOiiles:lyesk Vo <br /> Name of facility: Phone: <br /> Address of fah; :PREPARE FOOD ON 51TE <br /> 5. 1 am providing a bo ci my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> iaening, <br /> booth with walls and ce€ling constructed of either wood, canvas, plastic, similar material and line mesh fly 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 boltied water. <br /> �n-site hose bib that is connected to a potable water source. <br /> Cher s ecif <br /> ( p Yl:_— - - <br /> 7. Pec�irioiiy is provided for my booth's use Ye o/ No <br /> 8. 1 am providing an accurate probe the a5Ure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation Ye o <br /> 9. 1 am providing the lollowing'hot temperatu nir the hot holding of all potentially hazardous foods above <br /> 5°F: <br /> amp stove Sterno& hotel trays <br /> ouble steamer Stearn table& lids <br /> leciric 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 95205 I T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br /> EHD 16.02 Pago?of 11 TEIAP EVENT APP <br /> 06119I19 <br /> O <br />