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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> M food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checkrisl to <br /> the festival coordinator three(3)weeks prior to this event. <br /> (� �' 1i �(�1,,, r ,1 1Z2S <br /> t. t,Nsme of Event:t-i��ch�S1'>n�Q.-�U�Y �-�llll ��i_pate(s}: <br /> 2. The folbwing Is information about my organizationlbuslness: <br /> Name of organtzatton/buslness: <br /> Address: A1[-1� �Qt,�a�f1 �1�• �h �� y)qVV'39'- cjp�' Qs � <br /> Phone: (zS )'45--a Alternate:( ) <br /> 3- List food to be sold or given to the publim <br /> pt�4bQ5 03 <br /> 4, 1 ern providing food that is NOT prepared at home:'Yes❑No All food is prepared on-site or is from approved commerdal cifilies: Yes❑No 7 CIF <br /> A if <br /> Name offaality oY one: <br /> Address of facility, 17M #V yj4-t j. <br /> 5. t Sin providing a booth with the following:(to protect my unpackaged food and food-preparation areas from files,1776L09 e-e, <br /> �dust and the public) <br /> �},r 3 <br /> ,�+booth with walls and coiling constructed of either wood,canvas,plastic,similar material and tine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanable floor(concrete, <br /> asphalt,dean tarps and smooth wood are acceptable)and oonstructed to separate food and food preparation <br /> areas frnm the public. <br /> ❑Other(spay): <br /> Note: The only operations not required to provide endosed 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 /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. 1 <br /> U�a�er [,om l <br /> 7, Eleectr�icity(is provided for my booth's use:)d Yes U hlo�f�+ <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,29 Yes❑No <br /> 9. I am providing the following hot temperature control for the hot holding of all polel'ntlally hazardous foods above I <br /> 135T <br /> ❑camp stove ❑Stemo&hotel treys <br /> ❑Doubie steamer Steam table&Ilds 1 t <br /> ❑Electric stove top ®Other(spay) 4t`0 A� S�O <br /> Note: Examples of pot `K_fr <br /> endally hazardous food Include; mists, -females, cooked Keane, rice <br /> "SoUblos,Potato salad,eggs,and dalry products. <br /> 1868 E,Hazetton Avenue I Stockton,Callforn}a 95205 1 T 209 468-3420 I F 209 464-0138 I www.$)gov.orgfehd <br /> EFq 1f0 <br /> urroula24 Prpe 7 of 11 TEMP EVENT APP . <br /> z� <br />