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SANJOAQUIN <br />Date(s):/?^^ 2^. 2d25 <br />1. <br />2. <br />Address:A <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />SZOn-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />9. <br />vegetables, potato salad, eggs, and dairy products. <br />7. <br />8. <br />Environmental Health Department <br />foods during all times of booth operation: 0 Yes No <br />lam[ <br />135°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br /> Other (specify): ____ <br />Electricity is provided for my booth’s use:tZl Yes No <br />I am providing an accurate probe thermometer to measure <br />______ _________ZT' - — “ ) <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br />Q^Other (specify) <br />>c'f- %• <br />r-p \ -----------------, _ <br />------COUNTY— <br />Ureotness cjrows he <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Other (specify):_ _ _ __________________________— <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />S2fApproved bottled water. <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. Name of Event: A//Q /7 / <br />The following is information about my organization/business: <br />Name of organization/business:^/-/-/?-/^^/?^ A/ J=^/ <br />/Z.33S . Oft- ^21/0_______:______ <br /> (2^ ) 8^/57 Alternate: ( 3^ - 2 3.5------- <br />List food to be sold or given to the public: f --------- <br />I am providing food that is NOT prepared at home: LU Yes [^No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: &LK&LL Phone: —C/ 7^ — <br />Address of facility:________________ _—— <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, 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 />1868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov^g/ehd^ <br />EHD 16-02 Page 7 of 11 <br />nsna/on-n <br />meats, tamales, cooked beans, rice,