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R EC-008 <br /> S A N )OAQUI N Environmental 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. I'Name of Event: �5t+_ i n L �c�f , Juneteenth Date(s): Sr 16 /49 <br /> 4 of July Cultural Celebration Light up Main Street 6/1 5 714 7120 8117 9/21 <br /> 2. The following is information about my organlzalionlbuslness: 12/6 <br /> Name of organization/business: <br /> Address: C>� ) C-u. LA r C \ 15j <br /> Phone: 7 - 9 Q,5a2 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:❑Yes MNo -y�—�o <br /> All lood is prepared on-site or is from approved commercial facilities: ❑ Yes RNo f + o <br /> Name of lacility: Phone: <br /> Address of facility: <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 /> 1�_m(A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, completely anclosing 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 /> ❑Other(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[or drinking,utensil and hand washing will be provided In my booth by the following methods: <br /> Approved bottled water. <br /> ❑On•slte hose bib that is connected to a potable water source. <br /> ❑Other(specify); <br /> 7. Electricity is provided for my booth's use:❑ Yes N No <br /> B. I aryl providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑ Yes N No tJ�` <br /> 9, 1 am providing the following hot temperature control for the hot holing of all potentially hazardous foods above <br /> 135OF: <br /> ❑camp stove ❑Sterno& hotel trays <br /> ❑ Double steamer ❑ Steam tabfo&lids IV/1 <br /> ❑ Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: moats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> IM E. ii i/ellon Avenue I SloCktun,Californin 95205 1 T 209 468-3420 1 F 209 464-0133 1 wJ vw.s'1cov.ofgjF)l1d <br /> E41)16 07 PnQn 7 of 1 I TEMP EVEN 1 APP <br /> QW 1 FJ'19 <br /> 1 <br />