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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Address: <br />Phone: <br />I3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />TEMP EVENT AFP <br />\ <br /> No <br />to measure the hot and cold holding of potentially hazardous <br />Yes No <br />CK <br />)_______________________ <br />UH H J U M V V I 11 <br />------COUNTY------ <br />Q Other (specify): <br />Electricity is provided for my booth’s use: Ikf Yes^ <br />I am providing an accurate probe thermome' <br />foods during all times of booth operation: 0 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />O Camp stove <br />Q Double steamer <br />O Electee stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-34201 F 209 464-0138 j www.sjgov.org/ehd <br />EHD 16-02 Psge 7 of 11 TTT.'J'E*.T1“.'T <br />OSKWOOSS <br />AU 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 />1. Name of Event: Q <br /> Stemo & hotel trays <br /> Steam table & Gds <br />Esther (specify) <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />9* <br />Datefs): 4/27- <br />The following is information about my organizatiop/business: <br />Name of organization/business: _ <br />AT- 653---- Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0*Yes O No <br />AU food is prepared on-site or is from approved commercial facilities: 0Yes Q No <br />Name of facility: OcmmiSSTAVU IVAf CT Phone: <br />Address offedlity:^_^^^____]L£2£44—CffiV— <br />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 deanabte floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from toe public. | j . <br />-wed __s^.co__ <br />Note: The only operations not required to provide enclosed booths are those which sen beverages from <br />approved dispensers, or prepackaged foods from approved sources.