Laserfiche WebLink
Environmental Health Department <br />■I <br />o,( ,• <br />_ Date(s): <br />1. <br />2. <br />1(7 I <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />SAN JOAOUIN <br />COUNTY- <br />C'l < ulnr <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />' ) are required to return a signed and completed copy of this checklist to <br />/All |UUU VUIIMVIO --------—................. • ' ' <br />the festival coordinator three (3) weeks prior to this event. <br />CFo- <br />Phone: (?ot) --------- <br />lol — <br />packaged food and food-preparation areas from flies, <br />^YfAZ.Zt_<£ <br />O (9 ‘SV--C iVCy CT 2 <br />Phone: ( ^). 3-0 I <br />List food to be sold or given to the public:------ <br />I am providing food that Is NOT prepared at home: Yes Effio <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes I JNo <br />Name of facility: JuZFl^S .SUIf-'M-S -- <br />Address of facility:.. -----CL----- <br />I am providing a booth with the following: (to protect my un] <br />dust and the public) <br />□ A hodh with walls and celling —^‘her wood, canvas, pillar — ,^0 « <br />and'S? X"d Acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 />Q Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): ------------------------------—f=rr?r--------------------------- ”\ I amrAdinTan — p'mhe IhZom^r “measure the hot and cold holding of potentially hazardous <br />I amp S die Xing ho^X'Xe^roSor the hot holding of all potentially hazardous foods above <br /> Camp stove Sterno & hotel trays <br /> Double steamer steam table & llds <br /> Electric stove top Other (specify) <br />Noto: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy pioducts. <br />1868E.HazeltonAvenue| Stockton. CaHfomia 952051^209 468-3420 | P 209 404-0138 , —hd.com <br />EHD 10-02 <br />07/3/17 <br />All food vendors (both for profit and non-profit) <br />I.Name of Event: Co ---------------------------- <br />The following is information about my organizalion/business: <br />Name of organizalion/business: —73^ 1 S <br /> Alternate: ( )-------------