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R EC-008 <br />SAN ,JOAOUIN <br /> <br />Environmental Health Department <br />,—CIDU %TY- <br />9 -0•'3 6:rrtv. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (bon for profit and non-protit) are recuired to return a signed and competed cop/ of this checkist lo <br />the lestval coordinator three (31 weeks prior to this event - 41 pe.r1 <br />t Name of Event: M Dat-(s): H5Zil <br />The loaowing is Intomiation about my organizasortbusiness: <br />Narne of organizationtusiness: c-0 C)\,L N f" <br />Actress*. <br />1_ /K fi-rktXL.NV-(N (I\ <br />Phone: Alternate: <br /> <br />Lls-t food to be sold or given to the public: H's:1 koriiL or h lrt ) rt <br />I am providrg food thali.s NOT prepared at herre• es <br />food is prepar 4n-site is from approved commerc.al lacilrties es No <br />Name of faz:illty: Phone: <br />Address of facity: <br />I am providing a booth with the following: (to protect my urpacicaged food and food- prcparzil on areas from flies, <br />dust and the public) <br />booth with walls and ceiling constructed of er,her wood. canvas, plastc, simiar material and line mesh fly (tEr jig. completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />espial. dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Dther (spec:1 y): <br />Note: The only operations not required to pro+ide endosed booths are those which sell tevierages from <br />approved dispensers, or prepackaged foods from approved sources <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the followng methods: <br />7 -pprovect bottled water. <br />EDn-se hose bb that is connected to a potable water source. <br />her (specify): j, ‘)? \n(v.4' Sh.. es..--) c r r'eAri-t -tr..74,r .l.:7C,',r-i-vbe cirk_ (-2)L:-.<,, b,,a_ . -rs <br />city is provded for my booth's use IR o (i)cr -tc,590._ Cre-e-4-••"kke'- <br />8 I am providing an accurate probe the a. asure the hot and odd Witting ot potentially hazardous -- N L. <br />foods during all times of booth operator! • 'o <br />9. I arn providing the following hot temperat Ine hot holdng of all potentially hazardous foods above <br />g5°F: <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, doe, <br />vegetables, potato salad, eggs, and dairy products. <br />1858 E. Hazel:on Avenue I Stockton, Calilornia 95205 T 209 468-3420 I F 209 464-0138 i www•sigov-cogithd <br />Ti-VP Dif App <br />Scanned with CamScanner <br />amp stove <br />oube steamer <br />Iectric stove top <br />'ern° & hotel trays <br />team tab'e & ls <br />NoNokuy,, c n-t-rvAra• , S-Vtvc. 1 <br />,her (specify) <br />cr" -Ctt'Nc4NuArvkc,%-