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RL-C-pOA <br /> S A N D O A Q U IN Environmental Health Department <br /> C.0 U N T Y-.-.. <br /> rr <br /> i''(q ittttl C[F Cf�11f('SS <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (boil►for profll and non-P-oflt) are required to return it signed and oomp(elwJ copy of this checkllsi io <br /> the fesllval coordinator three(3)weelks vlor to this event, <br /> ( <br /> T. 1.Name of Event.NOO 1 c rn V 41 C. Ili fir?-�aY}� _faata(s): )Eq <br /> 2. The following is Information about my organ lzatiowbuslness: <br /> Name of organlzatlonlbusiness: <br /> Address: _,-15U& mev� t c�L "t57�7_0� �Y�-�� 1SC� ._C� ��1 cft <br /> Phone: Alternate: <br /> 3. List food to be sold or given to the pubilo: <br /> 4, 1 am providing food OT prepared at homp�eo0 <br /> All food Is preppy n•sit GIs from approved commorclal facllitIa0S- es3fo <br /> Name of faclffty: Phone: <br /> Address of facility: <br /> S. 1 am providing a booth with the following: (to protect my unpackaged food and laod-preparation areas from llies, { <br /> dust and the public) it <br /> ;C <br /> king, <br /> 00th with walls and ceiling constructed of either wood, canvas, plastic, similar material and line mesh fly <br /> 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 loud and food preparation <br /> areas from the public. <br /> ether(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages Irom <br /> approved dispensers, or prepackaged foods from approved sources. <br /> S. 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 /> "`�ther(specify). I r b -fury b n <br /> 7. `E eelMricity Is provided for my booth's use Ye No ar-t")p C-1� '� �'w j sUY.,-ri � <br /> f3. I am providing an accurate probe the gsure the hot and cold holding of poter♦tlally hazardous -tom. <br /> foodu during all times of booth operation Ye o <br /> fa. f am providing the following hot temperatu ntr the hot holding of all potentially hazardous foods above <br /> .amp stove Slerno& hotel trays <br /> ouble steamer Steam table &Ilds _ <br /> leclric stove top Ulher�igpealf y) b <br /> Note: Examples of potertlially hazartloua food Include: meals, tamales, cooked beam rice, <br /> vegetables,gatalo salad,epge,and dolry produo* <br /> 1868 E. Haxelion Avenue I Stooklon, Caillornla 952051 T 209 468-3420 I F 209 464-0136 1 www.slgov.org/ehd <br /> EHD peso Y of 11 TEMP EVENT APp <br /> 06119)19 <br />