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<br />Environmental Health. Department■i <br />All food vendors (both for profit and non-profit) are required lo return <br />1. <br />2. <br />cA <br />) <br />3. <br />4. <br />i <br />5. <br />6. <br />meats, tamales, cooked beans, rice, <br />! <br />! <br /> I <br />I <br /> <br />7. <br />8. <br />Name of organizaticn/business; <br />ISSaEHazellonAvenuel Sbcklon, California 95205 |T 209468-34201 F 209464-0138 1 wwvAsjcehd.rarn <br />EJiD 1S-02 aa <br />07/3J17 <br />SANJOAOUIN <br />-----COUNTY------ <br />Greulni-$s yrowi here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br />_ OatewJA^Oi^the festival coordinator three (3) weeks prior to this event. <br />LoT) 1 Sfc cck <br />r4’’"' • <br />'d <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 /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):---------------------------——---------------------------------------------------------------------Electricity is provided for my booths use: Yes Ld No <br />i am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times cf booth operalion: Yes No , „ x .. , . . , , <br />9. . . I am providing the following hot temperature control for the hot holding of all potentially hazardous .oods above <br />135aF <br /> Camp sieve Stemo & hotel trays <br /> Double steamer O Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />' vegetables, potato salad, eggs, and dairy products. <br />• IV!’ <br />. -T- • f <br />'/A.,.. <br />■I.Name of Event: <br />The following is information about my organizaticn/business: <br /> <br />Address: 'U^° <br />Phone: ( , 4 3 01 5_ <br />List fcod lo be sold or given to the public: <br />I am providing food that is NOT prepared at home: H'Yes No c <br />All food is prepared on-site or is from approved commercial facilities: 0Y es No <br />_ <br />Address of facility 3° ° A,»Jg-• -----?- ^1?-J------------- ------—— <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparatron areas from flies, <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material ancI line ^sh fly <br />areas from the public. <br />__________ Alternate^