Laserfiche WebLink
•�nArY <br /> SAN-JOARN Environmental HeaRh Department <br /> COUNTY— <br /> ': ,•�`� ` <br /> itF� ,"` Greatness grujrs here- <br /> T5MPORARY FOOD VENDOR'S APPLIOATIOIV <br /> All food vendors (both for profit 4n.d noOi Or6fit)acre iequired•to return a signed and completed copy Yf this.checklist to <br /> ire festival coordinator three(3)week%prior to.thl .event. J !� <br /> T. 1.NameofEVen'G ©Vl` �,. Y��"} . Date(s}: �Vi�Jti��04-41Z%Ib- <br /> 2: The following is information about my organJrafibfribusiness: <br /> irlai-ne of orgarirzaticnlbushn ss: <br /> Address: <br /> Phone: Alternate: <br /> 3. List'gad to be sold or given to the public: , f� !l_1��� 4'Il� <br /> - r <br /> 4. 1 atrl providing food that is NOT prepared at home:VYes❑No <br /> Ali food is pmpared on-site or is from approved commercial facilities:[(Yes❑No <br /> Name of facility.: G f r Phone: �7 -- <br /> Address of faciftrl <br /> 5. 1 am providing a booth with the•folfbtving:(to protect my unpackaged food and food-preparation areas from flies, ' <br /> dust and the public) <br /> { ❑A booth with walls and ceiling construetb¢of either wood,cahvas, plastic,similar material and fine mesh fly <br /> screening, coniplefely enclosing open food areas. It yr ll also have a smooth and cleanable floor (concrete, <br /> asphalt,clean tarps and smootfl wood are acceptable}and constructed to separate food and-food preparation <br /> areas from the public <br /> (Other(specify). <br /> Mote: The only operations not required to, provide enclose booths are those which, sell beverages from <br /> approved dispensers,or prepapRagedfeodvfrorn approved-sources. <br /> Q. Approved water for drinking,utensil and hand washing will be provided In my booth by the following methods: <br /> ❑Approved bottled water- <br /> Q On-site hose bib-that is.connected to a potebla.water source. ' <br /> Other'(specify): fr2GG P7,/[::.S <br /> 7. 51ecbicity is pfoviided for my booth'sPuse:,0 Yes❑No <br /> 8, f am providing an accurate probe-thermdt;sefei`to measure the hot and cold holding of potentially hazardous foods during all times ofbdoth Operation: 1 - e`s❑No <br /> 9. 1 aril providing the following hot teinperaWtatontrol for the hot holding of all potentially hazardous foods above <br /> 435°F: <br /> r]Camp stove ❑Sterno&hotel frays <br /> ❑Double stearner { Steam tabfe&Ifds <br /> M EIsctric stove top ❑Other(speciy) <br /> Nbte: Examples of potenVarly hazardads food Include: rtieats; tamale,-;, +rooked beans, Klee, <br /> vegetables,-potato sarad,eggs,arid d iry prpducts. <br /> r• <br /> \ 1868 E Hazelton Avenue I Stockton, California 952051 7 209 468-342Q l F 206 464-0138 1 www.sjcehd.cam <br /> [Hp 18-02 Page 7of 9 f TEMP EVENTAPP <br /> 4713h7 <br />