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REC-oos <br /> l� Envio-onmental Health Department <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): 9-21-24 <br /> 2. The following is information about my/rorganization/business: <br /> Name of organizatCio�n/business: <br /> Address. i Gi Lo kby-1 "i►e--- !✓r,VIA�Ikf, n /P�'� rC lam` `�5-3 c.1 <br /> Phone: Alternate: <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home:M1 esDlo All food is prepared on-site or is from approved commercial facilities:Z l eC�10 <br /> Gv <br /> Name of facility: ri E-1_ _ 0/ __Phone: <br /> ► L <br /> Address of facility:_ �1 `1 C,.1 Y Y L �'`�ti (eg r !`�o�'�.f Z r y, f `r' (-A <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) <br /> Ueninbooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> g, com letel enclosin o en food areas. It will also have a smooth and cleanable floor (concrete, <br /> completely 9 p <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 bottled water. <br /> Dn-site hose bib that is connected to a potable water source. <br /> 7. Uther(specify): <br /> rloity is provided for my booth's use ` Ye No <br /> B. t am providing an accurate probe the r asure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation e o <br /> 9. 1 am providing the following hot temperature c ntro f the hot holding of all potentially hazardous foods above <br /> 5°F: <br /> amp stove Sterno&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 /> 1868 E.Hazelton Avenue I Stockton,California 95205 1 T 209 468-3420 1 IF 209 464-0138 1 www.sigov.org/ehd <br /> EHO 16.02 Page 7 of 11 TEMP EVENT AP <br /> 06119/19 <br />