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SANJOAQUfN <br /> Environmental Health Department <br /> ----C O U NI T Y-- <br /> L�r;r:t:,5':�; <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: LPLN� g2R- �� �- - - —Date(s): 5 <br /> 2. The following is information about my organization/business: <br /> Name of organizationfausiness: G`f � Y}'kL CA h � <br /> Address: �� � i k( fG <br /> Phone { f ) 65 "q c)� l Alternate:( ) L C. <br /> 3. List food to be sold or given to the public: G'C Y i L d��-" Ste' <br /> aAbU <br /> 4. 1 am providing food that is NOT prepared at home:19Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities: Yes El Noo} <br /> Name of€acility. 1 (` Phone:M1 53 -L R15 <br /> Address of facility: 0�>Jb x- <br /> 5. lam providing a booth with the following:(to protect my unpackaged food and ond-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 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. <br /> M'Other(specify): r?� �p}� r�O I�� C �qFJ O1J <br /> Note: The only operations not required to provide enclosed baaths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 0. 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 <br /> ��isgqconnected to(a�potable water source. } <br /> Other(specify):. No �;(1 l.'tK-�" u l(>Si t w A\ )ve-L6 <br /> T lectricity is provided for my booth's use:❑Yes EJ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Yes TX No <br /> 9, 1 am providing the following hot temperature conlrd for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑camp stove ❑Sterno&hotei trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top V Other(specify) NIP, <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 952051 T 209 468-3420 j F 209 464-0138 j www.sjcend.com <br /> EHO 1E-02 Page 7 or t1 TEMP EVENT APP <br /> P713h17 <br />