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SAN JOAQUIN <br /> C.OU NJ V Y <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. 1.Name of EVEnt:�� c•� s �y�l�s•'7` �C�k.�• f __ Qate(s; �—�f jb--5 —Z�Z <br /> 2. The following is information about my organization/business: ! <br /> Name of organization/business: K : .i.�./y-:p_� Z <br /> Address: <br /> Phone: iS S ;-3-;-3 -G(1_Z S Alternate:(c11E ) /1- ;5_`k S 6> <br /> 3. List food to be sold or given to the public: r;: 1,- �% :(C _W •J-1 rc r s fi. a -/rc <br /> 4. 1 am providing food that is NOT prepar"at home:❑Yes L?,I`10 <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes <br /> Name of facility: phone: _ <br /> Address of facility:_.._. <br /> 5. 1 any providing a booth with the following:(to protect spy tinpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood,canvas, plastic, similar material and fne mesh fly <br /> screening, completely enclosing open food areas. It W-11 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 oublic. <br /> Note: The only c.parations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers.or prepackaged foods from approved sources. <br /> o. Approved water for drinking,utensil and hand washing will be provioed 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): <br /> ? Electricity is provided for my booth's use:]Yes ]Ito %-I,-I, <br /> B. I am providing an accurate probe tharrnorneter to measure the hot and cold holding of potentially hazardous <br /> foods during all tirres of booth operation:❑Yes❑Na y//1 <br /> 9. I ant providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135T: <br /> ❑Camp stove ❑Sterna&hotel trays <br /> E. Double steamer ❑Stearn table&lids <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.I-iazelton Avenue I Stockton, California 9r2051 T 209 468-3420 1 F 209 464-0138 I vNAv.sjcehd.corrl <br /> Fdr1!6-1-12 Pap Of i TL-.'.L'e`JENT <br /> 67.3i1 ASP <br />