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SAN JOAQUIN Environmental Healih Department <br />Name of organization/business: LAIAkt.:1-74 D;• <br />Phone: 2_4°Lk ss' Alternate: <br />R EC-008 <br />COUNTY— <br />(,) <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 />Music in the 2( ,2D,2_'1 1.Name of Event: Date(s): <br />The following is information about my organization/business: <br />Address: L.4Lke-5 Lac-c-A, Cs+, AA4 vi 1404'J2-- <br />List food to be sold or given to the public: 6- 1.4 4130/1A,--- (---Vae;51“3 <br />lam providing food that is NOT prepared at home: es \lo <br />All food is prepared on-site or is from approved commercial facilities' <br />Name of facility: <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food arid food-preparation areas from flies, <br />dust and the public) <br />Ubooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />ening, 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 /> <br />-c--x=c3,, [r (specify): '-"V"\xsck--- <br />Ncrte: The only operations not required <br />approved dispensers, or prepackaged <br />Approved water for drinking, utensil and <br />to provide enclosed booths are those which sell beverages from <br />foods from approved sources. <br />hand washing will be provided in my booth by the following methods: <br />plApprovecl bottled water. <br />a potable water source. rThn- e hose bib that is connected to <br />\•12)C Lk3c.,.)\-ty• 'her (specify): FtsbC.St- "k-Nrest. <br /> ETctrici1y is provided for my booth's use e: No <br /> I am providing art accurate probe the asure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation Yes No <br />9_ I am providing the following hot temperatu e contro o the hot holding of all potentially hazardous foods above <br />F: <br />amp stove <br />ouble steamer <br />lectric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazeiton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />END 16-02 Page 7 of 11 TEMP EVENT APP <br />06/10/19 <br /> Phone: <br />rno & hotel trays <br />Ste table & lids <br />her (specify)