Laserfiche WebLink
<br />I <br />i <br />• •. * ’ ' - -i'j’ <br />Environmental Health Department n <br />• -e;■ 7r?,".<7AV-;^~cd <br />K|J . B <br />... <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/18/w Page 7 of it.. <br />Alternate: ( )_______ <br />,, SiyMp^, maOarto\ <br />,. UYeeDNo <br />Ihone:/?^ ^8 I <br />“ C^A . ? f : <br />SihJBUIN . <br />C:^t^ ,ter, ... . ... <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />■ 1. I.Name of Event: ._L^ Vaa|c|4:Date(s): Aufl. <br />2. The following is inf^npatlon^boukm^bf^antzaUon/buttlnlBee: , <br />Name of organMon/buelneBs: . uk DtAV.lfy £>L)A <br />Address: 4^.0 ll lp '?) AW /i <br />Phone: , <br />3. List food to be sold or given to the public: zdcvnn .-4C11 U A <br />4. I am providing food that Is NOT prepared at home:^ Yes □ No <br />All food Is prepared on-site or is from approved commercial facilities: S <br />Name of facility: 10 H) ty\ ________PI <br />. . -/.Addressjof facillty-lKlg^g^O <br />5. I am providing a booth with the following: (to protect my unpacksged food and food-preparation areas from flies, <br /> Avbobth with walls and celling bonstnjcted of either wood, canvas, plaslfc, similar hiaterfal and fine meeh 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 />pother (specify): 10 Y 1-V . ___ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from r <br />approved dispensers, or prepackaged-foods from approved sources. <br />6. Approved water for drinking, utensil and hand washing,will ba provided In rny boothby the following methods; <br /> Approved bottled.water. <br /> On-site hose bib that Is connected to a potable water source. <br />Q Other (specify): ;\ _______________ <br />foods during all times of booth operation: YesS. No \) A <br />9. I am ^providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top jS^Other (specify) /\J A <br />Note: Examples of potentiaily hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.