Laserfiche WebLink
■'I Environmental Health Department <br />copy of this checklist to <br />2. <br />3. <br />4. <br />5. <br />are ttrose whfch Averages from <br />6. <br />9. <br />7. <br />8. <br />UH’ ; <br />.V.«rCTvv <br />-----DBte(s)< 1(5-/^ 2f>2J^ <br />’“toteA»®l Stockton, California 952OT | T 209 468-34201 F 209 4644)138 I www.sjgov.org/ehd <br />08/19/19 • rase 7 «It TEMP EVENT APR <br />SAMAOUIN <br />------COUNTY------ <br />Greotness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />ST to a ^ned and completed <br />1. 1. Name of Event:C^£> <br />The following is information about my organfzation/business: <br />Name of organlzation/business: TfeftOllzI ^&f> f <br />Address: <br />Phone: AiteIriate;( , _____________ <br />List food to be sold or given to the public: <br />1 am providing food that is NOT prepared at home: E<es No <br />All rood Is P^Paredo^te or fe from approved commercial facilities: [g<es No ~ <br />Address of faC|||ty;_/A7 - <br />Tustandte the rny unpackaged food and areas from flies, <br /> Other (specify):____________ <br />N°te: ISbroveddSf"8 001 reqU"'1e<1 ,0 Provitte errclosed booths are those which sefl beverages from <br />approved dispensers, or prepackaged foods from approved sources. u^dges rrom <br />Approved water for drinking, utensil and hand washing will be provided In my booth by tlie 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 pravlded for my booth’s usee 01 Yes No---------------- --------------------------------------— ---------- <br />holding of potentially hazardous <br />improv'd1"8 the following hot temperature control for the hot holdlng of all potenUaBy hazardous foods above <br />tx^Camp stove Q Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top ^er (spec,M <br />N0‘e: Hee,