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SAN JDAQUIN <br /> Environmental Health Department <br /> - <br /> �,,,,,, (�rrudnrsi rfr �rs ! •� <br /> TEMPORARY I=OOD 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: Lodi Street Faire Date(s): 5111202 <br /> 2. The following is information about my organizaticn/business: <br /> Name of organizationlbusiness: Fabula Tea <br /> Address 241 Lafayetle Cir Apt 4,Lafayette,CA 94549 <br /> 925 338-9739 Alternate: <br /> Phone: ( ) ( ) <br /> 3. List food to be sold or given to the public: Loose Leaf Tea <br /> 4. 1 am providing food that is NOT prepared at home:❑x Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities: x❑Yes❑No <br /> Name of facility: Savor House —Phone:( 925) 566-4877 <br /> Address of facility: 2525 main St.Oakley,CA 94561 <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 61her wood, canvas, plastic,similar material and fine mesh Ry <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): n/a <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ©Other(specify): n1a <br /> 7. Electricity is provided for my booth's use: ❑Yes 0 No <br /> 8. 1 am providing an accurate probe thermometer to measure the h6t and cord'holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes E]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 /> U Camp stove ❑Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top [A Other(specify) nla <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420! F 209 464-0138 1 www.sjcehd.com <br /> EHo 16 02 Pngm 7 al I TEMP EVENT APP <br /> 0713f17 <br />