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■ n�N <br /> $A RsJ O A Q U I N Environmental Health Department <br /> COUNTY—Greatness grows here. <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-pro"') are required to return a signed and cornpieted copy of tfiis ehed'&A to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: <br /> T T'N O1.�� <br /> 2. 1Tre foilamng is information about my organization/,business: <br /> onn <br /> Name of organizationftsiness: �lV..R -j& �! 1 <br /> Address: PII�JW 3 I*L^1TV4 FOA19 / C&V <br /> Phone: { �� ) ��f ern b ) <br /> s. List food to be sold or given to the public: <br /> CAZ irf4 <br /> 4. 1 am providing food that is NOT prepared at home: [Yes❑ No <br /> Ail food is prepared o fte or is from approved commercial facilities: P(Yes❑No <br /> Name offacHity C Phone: <br /> Address of t) _tLA-y1'1W1J 11 <br /> 5_ 1 am providing a booth with the following: (to protect my unpa&aged 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 /> 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_ 114U R /� /` <br /> CIS <br /> Other(specify): Cr <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 /> fi_ Approved water for drinking, utensil and hand washing will be provided in my booth by the fo Ilawin9 methods: <br /> Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> i ❑Other(specify): <br /> 7- Electricity is provided for my booth's use: Yes ❑ No <br /> 8. 1 am providing an accurate probe thermomet to 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 /> Wn 5"F: <br /> r-jCamp stove mo&hotel trays <br /> ❑Double steamer earn table&lids <br /> ❑Electric stove top Other(specify) <br /> Notre: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 1868 E. Hazefton Avenue J Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> EHD 16-M Pago 7 or 11 TEMP EVENT APP <br /> 07MI12025 <br />