COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

SA N J 0AO U I N E_nvlrot1mental Health Department TEMPORARY FOOD VENDOR'S APPLICATION All food vendors(both for profit and non-profit) are required to return a signed and completed copy of this checkfist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: , I TOPS&GOBLINS BEER TEST .. _.. _- gate(s)OCTOBER 29,2022 2. The following is information about my organization/business- Name of organization/business: Address: 1 /rt 0~. e 1 1 } ' ,tl J CAL C� L7S6 fI p Phone 10 1_ 0� - 3 List food to be sold or-given-to the public: _ Alternate: (a�� ) a 17 4. 1 am providing food that is NOT prepared at home: Yes❑No All food is prepared on-site or is from approved commercial facilities:t es ElNo Gr Name of facility: L ne:IW) `7 og— Address of faeih y: fte soya 5, t am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. [ Other(specify): �� Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. G. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: ❑Approved bottled water. ❑ On-site hose bib that is connected to a potable water source. yY Other(specify): 3 5 )n�i hC+-+/1e�-�� f(" 'I T� f !T�i� 7. t=lectricity is provided for my booth's use: Yes❑ No 8. I am providing an accurate probe theretomZ er to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes❑No 9. 1 an)providing the following hot temperature ontrol for the hot holding of all potentially hazardous foods above 135°F: ❑ Camp stove ❑Slerno&hotel trays ❑Double steamer ❑Steam table&lids r ❑Electric stove top �2 01her(specify) :r—f�C1+ Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables, potato salad,eggs,and dairy products. 1808 E.iiazelton Avenue I Stockton.California 952051 T 209 468-3,1201 F 209 46A-0138 1 www sj(jov orglehd EIID 10-02 Page 7 of I I TEMP EVENT APP 0G119119