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Envirasimentell Heafith Departmeimt <br />Date(s):1. <br />2. <br />Phone; <br />3. <br />4. <br />5. <br />/ <br />6. <br />8, <br />meats, tamales, cooked beans, Hee, <br />( <br />7. <br />8. <br />Alternate: ()_________—— <br />.(,ou;.v : <br />-•Lilt’ <br /> Other (specify);—— —-------------------------------------------------- <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or propackaged foods from approved sources, <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />[_J Approved bottled water. <br /> On-site hose bib (hat is connected to a potable water source. <br />1868 E. Hazelton Avenue | StooMon, California 952051 T 209 468-34201 F 209 464-0138 | ww.sjcehd cm <br />Pan/»7 nf 5*1 luNir *»• •EHD 16-02 ■ ' ‘Dl ” <br />OZ/.I/IZ <br /> Other (specify):.----------------------------z----------------------------------------------------------------- ----------------------- <br />Electricity is provided for my booth's use: Yes U No f t , <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 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135QF: <br /> Camp stove O Slerno & hotel trays <br />Q Double steamer O Steam table & lids <br /> Electric stovo top E.I Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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 />-(.Name of Event: -------/ <br />The following Is information about my organization/business: <br />Name of organization/business;flo ‘4' <br />Address: /Z, <br /> <br />List food to be sold or given to the public: <br />I am providing food that Is NOT prepared at home:^ Yes No <br />All food is prepared on-site oris from approved commercial facilities: 0 Yes No <br />Name of facility;Phone: {------------------------------------------- <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 /> A booth with walls and colling constructed of either wood, canvas, plastic, similar material and lino mosh fly <br />screening, completely enclosing open food areas. Il will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separata food and food preparation <br />areas from the public. <br />.. . x SAN.UOAQUIN <br />: ■■ k; C O U N T Y— <br />'■•'i.^ovA'7 Grcclimss grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />.p*