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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: <br />2 <br />Address: <br />Phone: <br />o. <br />4 <br />5 <br />6. <br />9 <br />meats, tamales, cooked beans, rice, <br />7 <br />3 <br />SAN JOAQUIN <br />------COUNTY <br />1868 E Hazelton Avenue Stockton <br />FHO ’«-02 <br />the festival coordinator three (3) weeks prior to thi: <br />1. <br />California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pace 7 o( 11 TEMp EVENT APP <br />All food vendors (both for profit and non-profit) are required to return a feigned and completed copy of this checklist to <br />2e (3j weeks prior to this event. ( <br />fiptrad/ oV Li'otnR __Date(s): <br />The following is information about my organization/business^ <br />Name of organization/business: Pantfcs <br />SizoaHoio Ln, LoJf , CA ______ <br />(^30 ) ~~~? Ip _____~~r” A'^mate: 7____ <br />List food to be sold or given to the public: siVLaL^cT MiflcU si pW <br />I am providing food that is NOT prepared at home: p^Yes Q No <br />All food is preparedon-site or is from approved commercial facilities; ^Pfes O No <br />Name of facility: t Phone: XSV3 <br />Address of facility JSS" fC . GuTl^i Cfir ty&yC) ____________ <br />1 P^^th^ 3 ^bl^)1 W'^ ^°"0W*n^: Pro^ec* mY unpackaged food and food-preparation areas from flies, <br />. j A booth with walls and ceiling constructed of either wood, caqvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also hjave 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 />i^Other (specify): -W -TmLkrL_____________ <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />Fl On-site hose bib that is connected to a potable water source. <br />Q Other (specify): ___________ <br />Electricity is provided for my booth’s use: [g?Yes No ' ~ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operatiom^TYes | | No <br />1 ar? por°vidin9 the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />KI*) l“ . <br />iD Camp stove UJ Sterno & hotel trays <br />^double steamer jx3^team table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.