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- V <br /> Date(s):1. <br />2. <br />Name of organization/business: <br />3. <br />■'LvechA/xi (>-on7O-icVU^) <br />4. <br />Xi <br />5. <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />The following is information about my organization/business: <br />U M II -sv V « v u «• 1 <br />------COUNTY------ <br />G'i'cjtness croiv.? here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />1. Name of Event: l5lAlM&5 CIFM <br />Note: The only operations not required to provide endosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. > <br />•• *'* ♦ <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />1868 E. Hazelton Avenue [ Stockton, California 95205 | T. 209.468-3420 | F 209 464-0138 | www.sjgovxrr^eh^ <br />EHD 16-02 PageTofll <br />06/29/2023 <br /> Other (specify):__________________________________________________;------------------------------— <br />Electricity is provided for my booth’s use: Yes j^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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: : <br />Camp stove l~~l Sterno & hotel trays <br />Double steamer Fl Steam table & lids <br /> Electric stove top Other (specify) <br />Alternate: ((,50 ) ~ 5^23 <br />I am providing food that is NOT prepared at home: Yes UNo <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: _ ___________________- Phone: (-------1 <br />Address of facility: ________ _ ___________>;------------ <br />I am providing a booth.with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />5^ A booth with walls and ceiling constructed of either wood, canvas, plastic; similar material and fine mesh fly <br />Careening, complete!^ 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. <br />Address:__________________ _— <br />Phone: (££>O ) 1~ 43%___________ _ <br />List food to be sold or given to the public: