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A-1 )Soti 61-1-ffle- <br /> S A N J Old g U I N Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for pront and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Everts: HOPS&GOBLINS BEER FEST __ Dale(s)OCTO©ER 29 2022 <br /> 2. The following is information about my organizalionlbusiness: Name of organization/business: <br /> Address: <br /> Phone: <br /> 3. List food to be sold or given to the biic: 47r- :4\ Alternate: <br /> 4. 1 am providing food that is NOT prepared at home:0 Yes❑ No <br /> All food is prepared on-site or Is from approved commercial facilities:❑TYes❑No <br /> Name of facility: Phone:(-,), <br /> Address of facility. i.'A,% ' ,v ' % ` — <br /> `. � 5. 1 am providing a booth with the following: (to protect'm <br /> dust and the public) y unpackaged food and food preparation areas from flies, <br /> ❑A 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. <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 /> G. Approved water for drinking, utensil and hand washing wilt be provided in my booth by the following methods: <br /> U Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> L)Other(specify): <br /> 7. Electricity is provided for my booth's use:❑Yes E71 No <br /> 8. 1 am providing an accurate probe thermometer 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 /> j 135°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. F-lazelton Avenue:l Stocicton,cal,fornia 95205 1 T 209 468-34201 F 209 464.0138 1 .vww.si9o- .org/chd <br /> 611DID t19 Page Tel 11 TEMP EV[N1 APP <br /> OW19li9 <br />