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Oct 01 18, 04:46p p.2 <br /> , <br /> S A N J O A Q U I N Environmental Health ROM" <br /> COUNT Y --- <br /> OC 1 0 0 2018 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> vt lzON n l E i\iTAL <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy <br /> the festival coordinator three (3)weeks prior to,t#i<S event. �. <br /> 1. 1.Narne of Event: r1�[�}_U%� �- <br /> 2. The following is information about my organization/business:Name of organizationtbusines )� L ILL <br /> kA_0­) Ov,4 ::14 -4 <br /> Address: � <br /> Phone: ) Alte mate: 11-- <br /> 3. List food to be sold or given to the publi <br /> 4. 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-site o is from approved opmmerciai facilities: Yes[] No <br /> Name of facila r' 3 1'1T/� Phone: ( ) <br /> Address of facility: <br /> S_ 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 /> booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> creeping, 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 /> ❑Other (specify): <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 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): <br /> 7. Electricity is provided for my booth's use: Yes ❑No <br /> 8_ 1 am providing an accurate probe thermometV io measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135`F: <br /> ❑Camp stove ❑ Stemo & hotel trays <br /> Double steamer ❑ Steam table &lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> {dote: 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 1 F 209 464-0138 i www.sicehd.com <br /> Received Time Oct. 1. 2018 4:46PM {lo, 4195 <br />