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*» <br />I <br />SAN-JOAQUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 <br />^71. <br />'/i2 <br /><«A <br />Phone:) <br />3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />6. <br />Njk 9. <br />meats, tamales, cooked beans, rice, <br />s,i <br />K)k 7. <br />k)L 8. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Alternate: ( <br />(3) \VtH»ks |IIHH to UllH OVIMll <br />1 NaiiiH ot Event r'A'1- y-.x « <br />J <br />1868 E. Hazelton Avenue | Stockton, California 952051 T 209 468-3420) F 209 464-0138 | www sjgov orq/ehd <br />S,”7 Page 7 of 11 TPMPEWNTAPP <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify):_ __________________________________ <br />Electricity is provided for my booth's use: Q Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazanjoua <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 /> Camp stove Stemo & hotel trays <br />Q Double steamer Q Steam table & lids <br /> Electric stove top 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 /> Approved bottled water. <br />; I'J'/M '!l 'i ’ // <br />I am providing food that is NOT prepared at home: GZTYes No <br />All food is prepared on-site or is from approved commercial facilities: [^fYes No <br />Name of facility: Ct) Phone ( S - $ V <br />Address of facility: ^o\ 5A-, , c C-A tySSp-? <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 ceiling constructed of either wood, canvas, plastic, similar material and fine mesh 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 separate food and food preparation <br />areas from the public. <br />All fotxf vondois ibi.lb foi pn>ht and nun puilil) >uo mquimri io lolurn h liigund and <xxriplnlnd copy of this checklist tn <br />fostival c(H>hlin<itor tbiuo (3) wnnks pmn to IhlH ovnnl , <br />I he following is Information about my ofgunlzallon/busineRS <br />Name of orgamzatioti/business: <br />Address: o r y^x o-v-^ Or. <br />(