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3 <br />1. <br />2. <br />Address: <br />^>10 )Phone: <br />3. <br />4. <br />1 <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />meats, tamales, cooked beans, rice,Note: <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />j Yes No <br />Phone: (___ <br />8. <br />............... ........ <br />------COUNTY------- <br />G.'v.cir-er.s qraher?. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Alternate: I V ) <br />X Az 6/ <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: iSlAlM&S C3FM <br />are those which sell beverages fromNote: The only operations not required to provide enclosed booths <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 />21 Approved bottled water. <br />The following is information about my organization/business: <br />LLC <br />v k t rx n C 4 .________________________ <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgovtor^eh^ <br />EHD 16-02 Page 7 of 11 <br />06/29/2023 <br />9^ <br />Name of organization/business: <br />T-o 5 ~ H 9 A <br />List food to be sold or given to the public:L. <br /> Other (specify):__________________—------------------------------------------------------------ ------------------ <br />Electricity is provided for my booth’s use: O Yes O 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 <br />Q Double steamer <br /> Electric stove top <br />Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home^J/fYes O No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: _• — <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 />0 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. <br />Date(s): 4/27-