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f <br /> �UI� <br /> - c� , SANzd0A 0 0IN Environmental Health Department <br /> COUNTY <br /> s'�� �'� Greatness grows here. <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 to this event. 't V V-v�1 1KM 4 <br /> 1. 1.Name of EvenWL" WAI �» 1 � Date(s): <br /> 2. The following is information aboutjXy organization/business: OaMM j <br /> Name of organization/business: LL( <br /> Address:,y i WhIiNblm ffl-..._Of HiW1 CA 01._0i'l <br /> Phone: (�o i. LVI 1.0 <br /> Alternate: ) <br /> 3. List food to be sold r given to th publi ml &W i1�� of-UNNf LEV <br /> C�rIV. . �i ., Nl�t lia!W4. Iam provi ingfood that is NOT prep�re: Yes ❑ No <br /> All food is prepared on-site or is from approved co ercial facilities: ❑ Yes ❑ No <br /> Name of facility: Phone: ( ) <br /> Address of facility: <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 /> ❑ 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. V0M - ■ • T Y <br /> Other(specify): _ ftiE Mo 01 L� <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 /> Approved bottled water. v TA i N K) <br /> On-site hose bib that is connected to a potable water source. . ��� <br /> ( P fy)M MICAUT� 1� 1*14 f <br /> 7, 1 cOther s eci <br /> 7. 1 ctricity is provided for my booth's use: ❑ Yes No <br /> 8. I am providing an accurate probe thermom er t No <br /> the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: MYes ❑ No <br /> 9. 1 am providing the following hot temperatur trot for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> Double steamer tteam <br /> table & lids <br /> Electric stove top ther(specify) , NJ om � � <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 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 07/0112025 <br />