Laserfiche WebLink
20E 5-16030fax. tc Intel 11 19/09/ 12'43 <br /> >:" [ Environmental Health Depa invent <br /> TEMPORARY FOOD VENDOR'S APPUCATION <br /> Alt food vendors(both for pro t and non-profit)are required to return a signed and completed copy of this checklist to <br /> tho festival coordinator throe(3) eks prior this event. <br /> t, 1.Name of Event: 07 } fk Dats(s): 4 <br /> i <br /> 2. The following is infarnation about my organizationlbuslnGss; <br /> Name of organ'izatlon/business: <br /> Address: <br /> . r-S= 9 t <br /> Phone: ( �•'f � �'. `f Alternate:( . ` - - <br /> 3. List food to be sold or given to the public,. r <br /> A. I am providing food that is SLOT prepared at home:❑Yes❑tea <br /> AIh food Is prepared on it is from apprerv�e.,df.commordal faplldes:►�4es C No <br /> Name of fedlkty `+`E5` �L c g Phent: , ,, s `i'''�<t <br /> Address of facility E r-Lt-f' 1 - Zx <br /> 5, 1 am providing a booth with tFre ollowing:(to protect my unpadraged food and food-preparation areas from ft'ses, <br /> dust and the public) <br /> booth with wads and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly <br /> screening, completely encioeing open food areas. it will also have a srnooth and cleanable floor(concrete, <br /> asphalt,clean tarps and smooth wood are aaooptal le}and constnlcfed to separate food and food preparation <br /> areas tram the public. <br /> 21&her(specif): <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 /> 6. Approved water for drtnking,utensil and hand washing will be provlGed In my booth by the following methods: <br /> L�Approved Mottled water. <br /> -a to hie bib that is connected to a potable water source. <br /> �DChar(sperX`y}: <br /> 7. Electricity is provided for my booth's use:❑Yes rl No <br /> t3. I am providing an accurate probe thermometer to rnonwr'e the hot and cold holding of potentially hazardous <br /> foods during all tunes of booth operation:[]Yes❑No <br /> 9. t am pxrAding the following hot ternpemiure conftl for the hot holding of all potentially hazardous foods above <br /> 135.°F: <br /> Eri5rnp stove Memo&hotel trays <br /> ❑trouble steamer ❑Steam table&kin J <br /> ❑Elactrlc stove top [g-Mor(specify) .' =.i `, 't'►Zf <br /> Note: Examples of potentially h=rdous food include: meats, tamales, cooked beans, rtca, <br /> vegetables,potato salad,eggs,and dairy Products. <br /> 1868 E. Hazelton Avenue; Stockton.California 95205 f T 209 468-3420( F 209 464-0138 1 www.slcehd.com <br /> EHD 16-02 Pape 7 d if TEMP EVENT APP <br /> 0713147 <br />