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AN JGAIJUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit 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 Event: HOPS&GOBLINS BEER FEST Date(s)OCTOBER 29,2022 <br /> 2. The following is information about my_ rganization/business: Name of organization/business: <br /> Address: <br /> Phone: <br /> 3. List food to be sold or given to the public: Alternate:( ) <br /> 4. 1 am providing food that is NOT prepared at home: Ll <br /> Yes <br /> All food is prepared on-site or is from approved commercial facilities:❑Yes C6No <br /> Name of facility: Phone: <br /> Address of facility: -- <br /> 5. 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 /> ❑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 self beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> G. Approved water for drinking, utensfl and hand washing will be provided in my booth by the following rnethods: <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 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 /> 135°F: <br /> ❑Camp stove ❑Slerno 8,hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> ❑Electric stove lop ❑Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> 18G8 E. Hazelton Avenue j '�dIOClklon,California 95205 I T 209 468-3,120 I F 209 4G4-0138 1 www.$)UDv urglehd <br /> E11D IG•02 Page 7 of I 1 TEMP EVENT APP <br /> OGI19n9 <br />