Laserfiche WebLink
M <br /> SAN.,JOAQUIN Environmental Health Department <br /> I_Ss ___COUNTY - <br /> Gi«utnrs5 rfro+.s l;c•r�. <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 top this event. <br /> 1. 1.Name of Ever..._ y(y) 't. " g _ Date(s): JZB <br /> 2. The following is information about my organization/business: <br /> Name of organizationibusiness:Dales Gourmet Kettle Popcorn <br /> Address: 1000 Church Street, Modesto,CA 95357 <br /> Phone: (209 ) 681-1730 r---NterncaSe: (209 ) 672-7939 <br /> 3. List food to be sold or given to the public: kettle Popcorn Agua Frescas\Cotton Candy <br /> 4• 1 am providing food that is NOT prepared at home:N Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ®Yes❑No <br /> Name of facility: Southeast Asia Grill Phone: (209 )996-0121 _ <br /> Address of facility: 2037 Tully Road, Modesto, CA,95350 , <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑x 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 /> ❑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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑x Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes 0 No <br /> 8, t am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:f])'es❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135`F: <br /> [camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> (Kettle cooker) <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. Hazelton Avenue[ Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 0713117 <br />