Laserfiche WebLink
� � w, ��0�l N Environmental Health Department <br /> k . <br /> COUNTY <br /> �'ri.r��,�,:•``"• (Tt't'rrfttc+ss tJt-c�4.15 �It�tr•, <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 priorto this event. <br /> 1. 1.Name of Event: jti� r �YI icy�. Date(s): ?_7 �[�; <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: *ry-� SCQ4 _5 <br /> Address: 1 3 2g/ �fT a,4 i�CA 9S-3 3 4• <br /> Phone: (01 ter ) ' �Z- -7�j Z/ r`�-la✓l e,rca> Alternate:{ 2 � <br /> 09) 2�`/-� a,�[� �7 � y'-5) <br /> 3. List food to be sold or given to the public: tr-e5A �� `©1'� <br /> 4. 1 am providing food that is NOT prepared at home:0 Yes ❑No <br /> All food is prepared on-site or is from approved commercial facilities:0 Yes ❑Nos�i&n,W <br /> Name of facility: Phone: { ) 4(?d WVI/0y <br /> Address of facility: 0 y S &_1 <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. // 1 <br /> ;Other(specify): ai� `7 — fi Gad k3 Adw <br /> G�u,rS•�Y1'�'� i �C•� <br /> Note: The on�perattons 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. <br /> ❑On-site hose bib that is connected to a potable water source, <br /> Other(specify): 1 j26 <br /> o `Iowd"Co <br /> 7. Electricity is provided for my booth's use: ©Yes [!2 No O i4{te_,�_'— <br /> 8. 1 am providing an accurate probe thermometer€o measure the hot and cold holding of potentially Kakardous <br /> foods during all times of booth operation: ❑Yes❑ No 1� <br /> 9. 1 am providing the following hot temperature control for the h66t holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑Sterno&hotel trays / q <br /> -'w /V�f'l <br /> []Double steamer ❑Steam table&lids <br /> ❑ Electric stove top Q Other(specify) <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 I Stockton, California 95205 1 T_ 209 468-3420 ( F 209 464-0138 1 www.sjgov.org/ehd <br /> END 16-02 Pagel of 11 TEMP EVENT APP <br /> 06/19/19 <br />