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Eovkoomeintefl H®s8th Departrwint <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />I. <br />9. <br />7. <br />8. <br />, plastic, similar material and fine mesh fly <br />areas. It will also have a smooth and cleanable floor (coijicrete, <br />•.eptable) and constructed to separate food and food preparation <br />SANJOAQUIN <br />------COUNTY------ <br />Grcutn/’ss yrnws hare. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-) are required to return a signed and completed copy of this checklist to <br />JXJU/O WUHMVIV J-..----------------------- • * t * | <br />the festival coordinator three (3) weeks prior to this event. . <br />naf6(s)5-?5 Id-kW <br />er tcTmeasure the hot and cold holding of potentially hazardous <br />2>.Yos | 1 No <br />control for the hot holding of ail potentially hazardous foods abiove <br />w i^7 <T<^ <br />meats, tamales, cooked beans, rice, <br />qSblO________ <br />Phone: ------------------------------- Alternate: ( )_-------------- --------/TT7~7 <br />List food to be sold or given to the public: ^(0^ 1 . <br />I am providing food that is NOT prepared at home^Yes □ No CPC-OU <br />All food is prepared on-site or is from approved commercial facilities: 7 es^ No <br />NamaofW IbmolW——-------- <br />dust and the public) <br /> A booth with wails and ceiling constructed of either wood, canvas, <br />screening, completely enclosing open food <br />asphalt, clean tarps and smooth wood are acct <br />areas from the public. <br />pother (specify): JlhJO------- <br />^ote: The only operations not required to provide enclosed booths are those which sell beverage^ from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drtnKng. 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 />''Sectricity is provided for my booth’s uAe: LJ YesT^l NS <br />I am providing an accurate probe thermomet! <br />foods during all times of booth operation: >2 <br />I am providing the following hot temperatun <br />135‘’F‘ <br /> Carrip stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top C^er (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1368 E. Hazelton Avenue j Stockton. California 96205 | T 209 468-3420 [ F 209 464-0138 | www.s^dp^ <br />EHD 16-02 a9~ <br />07I3J17 <br />All food vendors (both for profit and non-profit) <br />1. Name of Event M^I -------------------------------- <br />The following is information about my crganization/buslness. <br />Name of organization/business: 7 ----------- <br />Address: K