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S A N !O A Q U I N Environmental Health Department <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 L ec` '. L O ^—) polo{s) l <br /> 2 The following is information about my organization/business- <br /> Name of organ izationfbusiness: <br /> Address <br /> Phcne ( �1��? AlternateL( ) <br /> 3. List foots to be sold or given to the public: <br /> q- 1 am providing food that is NOT prepared at home: 51yies❑No <br /> All food is prepared on-site or is from approved commercial facilities: E Yes RNo <br /> Name of facility: Phone: ( l <br /> Address of facility <br /> 5. (am providing a booth with the following: (to protect my unpackagsd food and food preparation areas from flies, <br /> dust and the public) <br /> �A booth with wails and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh tly <br /> screening, completely enclosing open food areas. It wil( 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 /> Other(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 /> 5. 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 rs Wnrtected to a potable water source <br /> ❑ Other(specify) <br /> 7 Electricity is provided for my booth's use`� Yes�] No <br /> a I am providing an accurate probe thermometer to measure the hot and cold holding of potentially h <br /> foods during all times of booth operation 12 Yes ❑ No <br /> 8 ( am providing the following hot temperature control for the hot holduiy of a31 potentially hazardous foods at>o <br /> 13S"f- <br /> camp stove Sterna& hotel trays <br /> ❑Double steamer ❑ Steam table:& lids <br /> F1 Electric stove top ❑ 00ier(.specify) <br /> Note. Examples of potentially hazardous food include; moats, tamales. cooked Moans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> iGv3 L_ li,.:r,4oli Aw n.�e. <br /> t' <br />