Laserfiche WebLink
Document_2022-10-20_003212.jpg https://mail.google.eom/mail/u/0/7ogbl <br /> <br />SAN JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Address <br />Phons <br />3 <br />4. <br />6. <br />Approved water for drinking, utensil and hand washing will be provided m my booth by the following methods6 <br />[ I Approved bottled water <br />0 On-site hose bib that is connected to a potable water source. <br />9 <br />meats, tamales, cooked beans, rice. <br />10/20/2022, 7:14 PM1 of 1 <br />7 <br />8. <br />Note: The only operatons not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />Q Stcmo & hotel trays <br />O Steam table & Ids <br />D Other (speedy: <br /> A booth with walls and ceding constructed of either wood, canvas, piastre, similar materrat and hne 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 />Other (specify) <br />Note. Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />7 <br />I—-j f .ft her i specify / ..a....... t....... —... .............—.... ........... ....— ..... <br />Eleclncrty is provided for my booth's use i^Yes | J No <br />I am providing an accurate probe thermometer to measure die hot and coW holding of potentially hazardous <br />foods during all times of booth operation (^J'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 />D Camp stove <br />O Double steamer <br />Q Electric stove top <br />All food vendors (both for profit and non-prolil) are required to return a signed and completed copy of this checklist to <br />(he festival coordinator three (3l weeks prior to this event <br />firt Name of Event O/Chti/S b S Date(s) <br />The followng is information about my organizalionrbusiness (' (y - <^lSVY <br />\ S’O ! Sun cfrCh</6,.J <br />CtaAS S63 <br />i <br />--------- <br />Name of organization-business <br />I fa 6 Q Lor tjS-i' <br />______ Alternate: ( <br />List food to be sold or given to the public €5Cj d r> n <br />I am providing food that is NOT prepared at home: i^Yes 0 No <br />Ail food is prepared on-site or is from approved commercial facilities: l^KYes F! No , <br />Name of facility L-Q (QivU' SUn/ fl________________Phone ) 7?A " J <br />Address of facility .cQ. <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)