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Environmental Health Department <br />i <br />1. <br />2. <br />Address: <br />Phone. <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />9. <br />7. <br />8. <br />SANJOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br /> Other (specify):______________________ <br />Electricity is provided for my booth's use. Q Yes '^No “ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: EkYes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F■ <br /> Camp stove /\ / I A Sterno & hotel trays <br /> Double steamer ’ Steam table & lids <br /> Electric stove top Other (specify) <br />Date(s) <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 />t.Name of Event:. In <br />The following is information about my organization/business: <br />Name of organization/business: <br />Av-e rvyhi, <br />) gH- ^77^ Alternate. ( ) <br />List food to be sold or given to the public: DhVY SO(^C(S , <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: W-Yes No <br />Name of facility:Phone. ( ) <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />El A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />Screening, 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.