Laserfiche WebLink
a�• <br /> SAN, JOAOUIN Environmental Health Department <br /> COUNTY-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> A'food vendors(both for profit and non-profit)are required to return a signed end completed copy of this checklist to <br /> the fest}vat coordinator th (3)weeks prior to this event. <br /> t. I.Name of Event S <br /> 2. The following is information about m o an'l��-atior�usln> �,�^` <br /> Name of organizationbuslness: C. <br /> Address, na tr c <br /> Phone { �) 1 D' �s{lj-- Alternate:( ) <br /> 3. List food to be sold or given to the public: Lo-y1m e 1 'x` u <br /> 4. tam providing food that is NOT prepared at home:❑Yes;kNo <br /> Ail food is prepared on-site or is from approved oommerd I(acuities:PlYes ElNo !` <br /> Name of facimy. -0 hone:Q Z V91- U 7(r <br /> Address of facility -I S t) <br /> 5. 1 am providing a booth with the following: to protect my unpackaged food and food-preps on areas from fees, <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. h 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): _j y1 C' a Ara}lam <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from !r <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 /> I <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source, <br /> ❑Other(spay): <br /> 7. Electricity Is provided for my booth's use: Yes No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold hotding.of potentlally hazardous <br /> foods during all tlmea of booth operatlon�KYes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> ❑camp stove ❑Stemo&hotel trays <br /> ❑Double steamer ❑Steam table$lids l , <br /> ❑Electric stove top Xothar(specify) (J C(}((���} <br /> Note: Examples of potentially hazardous food Include: meets, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dalry products, <br /> 1868 E.Hazelton Avenue) Stockton,Callfomta 962051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ohd <br /> eNo1"2 P■ 7dtt <br /> 0710112024 TEMP EVENT APP <br /> t <br />