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V SANJOAQUIN ��u�rolnel$a� ��� �� Department <br /> -COUNTY <br /> _r <br /> �ltraovci¢'' Greatness grows here. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ali 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 threee(;3f)weeks prior to this event <br /> 1. 1.Name of Event: YJ3 tr y, =°.'�x�—� Qate.(s): <br /> 2. The following is information about my organ izatibnlbusiness: }} <br /> Name of organizatlonlbusiness: S 1 X-P eq r1 <br /> Address: &3q / 4 �fl l~ 144 _ <br /> -Phone: (2pQ) 63 1,00 Ze,,Q Altemate:( ) <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❑No <br /> All food is prepared on-site or is from approved commercial facilities:®Yes❑No <br /> Name of facility 1149y;\*'.GIs r- 6 Af v't 1 r 1 ��. Phone: ZOF 0,�1)14 g <br /> Ad& ss.offacility: o,91� A Ue, l� S 2 <br /> 5, f am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from files, <br /> dust and the.public) <br /> 1�9 A booth with walls and ceiling constructed of dither wood,:canvas, plastic, slmllar 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 frorri the public. <br /> ❑Qther(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 /> S. Approved wafer for drinking,utensil and hand washing w9I be provided In my booth by the following rtfefhods: <br /> Pd Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable.water source. <br /> 1]Other(spgoify): <br /> T Elecldcity is provided for my booth's use:❑Yes ]No <br /> 8. 1 am providing an accurate probe fhermometer to rrieasuee1118 hot and cold hdldiPg of potentially hazardous <br /> foods during all times of booth operation.M Yes❑No <br /> 9. 1 am providing the following hotlefnperature control for the hot holding of all potentially hazardous foods alcove <br /> 135°F: <br /> ❑Camp stave ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steeo#shie&lids <br /> ❑Electric stove top �E5' ar�specffy) P ice?Qn Q <br /> Note: 9xamples of potentially hazardous food include: meats, 'tamales, cooked beans; rice, <br /> vegetables,potato salad,egg-;;,.and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton,California 952651 T 209 468-34201 F 209.464-0138 1 www,sjcand.com <br /> AHD is42 Page 7of 11 MMP FVFNT APP <br /> pM'17, <br />