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SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR S APPLICATION <br />^5//(a. L r d1 Namo of Event1. <br />2. <br />f 5 V ?Address: <br />< 7?Phone <br />3 <br />4. <br />5 <br />6 <br />9 <br />7 <br />8 <br /> Siemo & hole! trays <br /> Steam table & hds <br /> Other (specify) f < CM t<< <br />meats, tamales, cooked beans, rice. <br />I Z <br />t R V/L.L.Ie UA-U,- <br />All food vendors (both for profit and non-proft) are to return n s<jr^d and rxrrx*^-**d o* 1 <br />the festival coordinator three (3) w«tK poor to thr» rr^-rrt <br />11 u | k ii c < d /C /X <br />The following is information about my oryanuatirxVbusmess <br />c H < c / > <br />I e <br />I am providing food that is NOT prepared at home [jj Yes No <br />.AH food is prepared on-sie or is from approved commercial facilities fl Yes fl No <br />Name of facility Phone ( )— <br />Address of facilky.------------------------------------------------------------------------------------------------------------------------ <br />I am providinfl a booth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />Name of organtzatlon/business d * < C C \ V] < < / > 3 r 1 * k <br />(/t? ) * ( ? Z Alternate ( <br />List food to be sold or given to the pubbe I u ■ 1«1 c, l P >- t ’• i <br />fl 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br />fl Approved bottled waler <br />fl On site hose bib that is connecled to a potable water source <br />fl Other (specify) V\, ! \( u r- 1 *''* ‘ it <br />Electncky is provided for my booth’s use fl Yes fl No <br />I am providing an accurate probe thermometer to measure the hoi and cold holding of potentially hazardous <br />foods dunng aM times of booth operation fl Yes fl No <br />I am providing the following hoi temperature control for lhe hot hotding of all potentially hazardous foods above <br />135-F: <br />fl Camp stove <br />fl Double steamer <br />fl Electric stove top <br />Note: Examples o< potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />j Tu,i. A ^»r j. L/i. f ’i <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, srniiar material and fine mesh fly <br />screening, completely enclosing open food areas. It will ato 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 />k \ < k c__________________________________