Laserfiche WebLink
Environmental Health Department <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />SANdOAOUIN <br />-----COUNTY------ <br />are those which sell beverages from <br />Jhdi8m2 HaZen°n AvenU6 1 s,0cl<,on. California 95205 | T 209408-34201 F 209 464-0138 ) www.sjgov.org/ehd <br />Oa/ia/19 ■ Paoc7«1* TEMP EVENT APP <br />■Mrcr;v' Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to 9nd “n’Pteted °fthls checkbl to <br />1. I.NameofEvenf—KfiWg- &JVP n^.j. <br />The following Is Information about myorganlzatlon/buslness: <br />Nama oforganlzation/business: Gd f <br />Add^ss: //^ <br />A,tenlate:( }__________________ ___ <br />List food to bo sold or given to the public; <br />I am providing food that Is NOJ prepared at home: ®^es No <br />Alt food Is Prepared^teo^forniapproved commercial facilities: ffiVea No ~ <br />Name of facilityPhnn*- <br />Address of faclllty:__/Z<? A>' C^- <br />* ^sTandthe puWteP Wlth fOl,OWin9: (t° P 1 my uriPacl<a9ed food and fid-preparation areas from flies, <br />are^s• pSV W0°d acGepte,bla, 8nd constructed to separate food and food preparation <br /> Other (specify):_____________________ <br />Note: The only operations not required to provide enclosed booths crc <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utenail and hand washing win be provided in my booth by the following methods: <br />^TApproved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br /> Other (specify): __________ <br />aectricity Is provided for my booth's use: ^Yes No ----------------- ----------- <br />1 the hot and cold ho'c,ino of poten,la"y ha2ardous <br />1 a1r2rP4O.Vldln9 the lowing hot temperature control for the hot holding of all potentially hazardous foods above <br />lop r» <br />[zJ-Oamp stove Q Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top (specify) , <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice <br />vegetables, potato salad, eggs, and dairy products.