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SAN JOAQUIN Envil'onnicotal Fseaith Depart[r>ent'- <br /> 0tINIi ". <br /> TEMPORARY FOOD VENOOR'S APPLICATION <br /> A{1 mad\cndC+rs looltt (��r p,oflt com'I ncn•proril).11"1cquiwj to rckfrrr:: Md copy of IN-A ct>>ck€5l to <br /> the festwat coordinator three t3)w oks ptior to this rat i`nI <br /> 1. 1.Name of Event: t " r`L � <br /> The follouittg is irt[omtialion about my orf-,3n:«rhQrEri u:•in-0::5 <br /> Name of orga11TzAtial ubusbiess: An 5-fu fi <br /> a - ; -S <br /> Address: -- t 1'r^Gj,! _Sw.s fin c ter- cA• <br /> Phone: (707 ) 39q,M l___T___^� Ahernate:{ ) <br /> 3. List food to be sold os given to the public T <br /> 4. 1 am providing food that is NOT prepared al home-I]-Yes U No <br /> All food is prepared on-stle or is from a proved commercial facilities. Yes�es[I No <br /> Name of facdily: J Si' h A . tl1 CD In u��hone: `f 2 7Z 9e) <br /> Address offacitily'_4j1 11i�(_ d `V L Sw15W ►'l r �it CAt _ S� <br /> am providing a Loath with the fal€owing: (to protect my unpackaged fcTA and food-preparation areas from flies. <br /> dust and the public) <br /> O, A booth vnth walls and ceiling constructed of eitherwaod,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 /> Mote: The only operations not required to provide enclosed booths are those -.�hich self beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> G. Approved crater 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 /> 00ther(specify): <br /> 7. Electricity is provided for my booth's use:❑Yes allo <br /> 6, 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> roods during all times of booth operation:[2 Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially ha-zardous foods above <br /> 135`F: <br /> ❑Camp stove ❑sterno C hotel Irays <br /> ❑Double steamer ❑Steam table S Gds <br /> ❑Electric stove top J I thcr(specify) tJIA <br /> Note: Examples of potentially hazardous food include: tneats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazellon Avenue I Stockton,California 952051 T 209 468-3420 I F 209 464-0138 I %wvtv.sjcehd.com <br /> El H)10-62 Vogl 7 w I; S E!J?Evr`a t A,o <br />