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- I- - <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />meats, tamales, cooked beans, rice, <br />Q Stemo & hotel trays <br /> Steam table & Gds <br /> Other (specify) <br />-----COUN~Y----- <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />)-------------------- <br />1 am providing food that is NOT prepared at home: Q Yes l^No <br />All food is prepared on-site or i <br />Name of facility: <br />Address of facility:^ <br />I am providing a booth with the foliowing: (to protect mykjnpackagi <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 endosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />□ Other (specify):/Y i <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 win be provided in my booth by the following methods: <br />7. <br />8. <br />r* <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />EWD1&02 P«g«7cf11 TEMP EVEMT APP <br />06/29/2023 <br /> <br /> <br /> Other (specify): ■■ <br />Electricity is provided for my booth’s use: Q Yes E3.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 operation: Q YesS No <br />I am providing the fofiowing hot temperature controTfor the hot holding of all potentially hazardous foods above <br />135’F: <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <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. <br />RIVSR ISlAtMQS _____________ <br />The following is information about my organization/business: <br />Name of organization/business; --------- <br />(2O^)_22£X1XZL2=l2 Alternate: ( <br />List food to be sold or given to the public: ^4 <br />Date(s): ' <br />is from approved commercial facilities: Yes S^No <br />_________A | yn.____________ Phone: ( ) ,_______________ <br />I^IIV / fy? _ <br />: ' * xjnpackagfed food andfood-preparatiefi areas from flies,