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SRN JOAQUIN <br /> C01,11\17 <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 threeS +(3)weeks prior tothis event. <br /> 1.Name of Event: Lq p t g_e 1 FA!p�g Date(s): � `F ZO2_6­ <br /> 2. The following is information about my organrzation/business: <br /> Name of organ iz nn <br /> izationn/busielss, _Rle-kkA2ps pyt} �7` cAls � DI MrJ Q�s <br /> Address: f t I CA eOL t Al4 &L/6 trr n QUI S�f. CA _L, r r� <br /> Phone: (5S� ) 39'7 438 Ica Alternate: (SS°l? .2��'- <br /> 3. List food to be sold or given to the puhf c I hj at <br /> �� M <br /> 4. 1 am providing food that is NOT prepared at home:❑Yes Jvo <br /> All food is prepared on-site or is Prow.approved commercial facilities:)&es❑No <br /> Name of facility: 1�4/8 Phone:L_ ) <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 /> ❑A booth with waifs and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh 1i� <br /> screening, completaiy enclosing open food areas it will also have a srnooth 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 qubiic. <br /> Other(specify): LLI� t?C DSCI) <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 /> On-site hose bib that is connected to a potable water source. <br /> Other(specify): C 17- �,,.)P rq� <br /> 7. Electricity is provided for my booth's use: Yes❑Ne <br /> 8. 1 am providing an accurate probe thermometer o measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding 0;all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove n Sterna&hotel trays <br /> CI Double steamer ❑Steam table&lias <br /> ❑Electric 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 F 209 464-0138 1 wvAv.sjcehd.com <br /> E11D 16-02 Pa e 7 of 11 <br /> ,P!3n7 9 TEMP EVENT APP <br />