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Environmental Health Department <br />2. <br />3.Pkrcto- <br />4. <br />5. <br />6. <br />9. <br />iiTkl <br />7. <br />8. <br />SAN JOAQUIN <br />COUN~v <br />Date(s): 11 - 1 <br />™HaZeltOnAVenUe| StOCkton’Ca'ifomia95^gl Tf20S 468-3420 | F 209464-0138 , -w.sjgov^/eh^ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator thrc^ th2 t0 3 S'9ried completed of checklist to <br />1. 1. Name of Event: Indi d <br />The following is information about my organization/business: <br />Name oforganization/business: JWIk <br /> <br />Address: P_Qt %cx / CA- ______________ <br /> Phone: (2___________ ^temate:(70V) <br />List food to be sold or given to the public: Pl ft fCSC r JKg_ J <br />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: E Yes No <br />Narneoffaci,ity; Phone /____) <br />Address of facility:-------------------------------------- --------------------------------- <br />' Zund ttie pSf Wi'h f°''°Win9: (t° PrOte0t my “"P301^ food and food-preparaton areas from flies, <br />X’“S PlaStiC'rilaJ Tteria' and fine mesh fly <br /> <br />pother (specify): 5 gfHnnkoU /rx^ r^fm <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[^Approved bottled water. <br />(3 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: E Yes No------------------------------------------------------------------------ <br />XjJSS;£X"K" “ “ •“ °' ™"“* <br />1 ^Pfovidtng 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 0 Other (specify) W^lWWMp5| <br />N0,e: . — beans, rice,