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Environmental Health Department <br />1. <br />2.J; <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />or given to the public: <br />Date(s): <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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):_______________________ <br />Electricity is provided for my booth's use: Yes No ————-- _ -------------- <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No A/. jn <br />| * I. . r »• • • ■ . . . . _ .. . <br />135°F: “ /V-^ <br />0 Camp stove <br /> Double steamer <br /> Electric stove top <br />SMJOAQUIN <br />- - COUNT Y-- <br />■ , E, Ct:.' (t, i -, .7; -j.vj llcl! . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />10 relUni 3 and complsled copy of ,his c,,ecklist f0 <br />1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: fo/vtL <br />List food to be sold <br />______ Alternate.' ( ) <br />I am providing food that is NOT prepared at home: (0 Yes No <br />All food Is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility. — - ------------. . Phone: ^7^7 <br />Address of facility; >//JT adXnd ihe pubbfc)h Wi,h the f°“0Win9: pro,ecl my food food-preparation areas from flies. <br />f-1U A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (cone efo <br />X^fro^the pXT* aCCeptab,e) and instructed to separate food and food preparation <br />0 Other (specify): ___________________________