Laserfiche WebLink
Environmental Health Department <br />leaked to return n signed and coriipietad cop-f c< this checMft to <br />1. <br />2 <br />Attanm <br />Phone <br />3. <br />4 <br />5, <br />6 <br />9. <br />-',a <br />meets, tamales, cooked beans, rice. <br />7a. <br />H"cKon Avenu01 Stockton. CaklomlB $5205 I T 200 468-3420 | F 200 464-0138 1 WYrw.sK«hd com <br />wSir " w MP s rtN t AM- <br />ABetnalc ( ) 4tt> .■?H>____________ _ <br />List (ood to bo coto « flavor- to the puoto yxtB <'•»» '-■« ci; -’: (>t--A -ur ■■ ■. i--;- o-.n »• botti-? wav <br />7lie tokwng is tr.fonnalior. abcx.t my organxalor/busrcM <br />Nltnw of orgrtm/Alw-i'bmuceM -oato <br />412 Bitn’to Way *?« 2 <:A 95356 <br />Oeto(s) iZ-7-^ <br />SAN JOAQUIN <br />-----COUN 1Y <br />. (>l>'nh» H /poi. I|,'« <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendo's (botn for profit ar d non-profit) are <br />fie festiviM coofdnntcr three (3) week* p».cf to t»w event <br />1.N«ne oi Ewr.t L &::,J £52^ Marec-i <br /> On-rlfe hose bib that is connected to a potabfe vratcr source <br />H Offer (tpeaty): z t> pr-Mi AMter tank <br />necbioty is provded for my tjcxun’s nw Q Yot 2] No " ~ <br />I nm ptovcing an Hccurate prcCe thermometer to measure the Hot arid cold hotorxi of potentially hraa'dc-us <br />feeds eformg d! tires of booth opcrM-on, 2j Yc» (j No <br />I am prow-ding tne fofiewing hot temperaiure control for the hot holding ef all polortally hsra-dous toons above <br />(-J Camp stove Q Stsmo 4 hotel treys <br /> Double stoomor Stoom table & Ids <br /> E'octre stove lop Other (speoty) <br />Noto; Examples of potontlahy hazardous food Include: <br />vegetables, potato salad, eggs, and dairy product*. <br />Note: Tie operations not required to prov.de enclosed booths are Ihose which sei. beverages from <br />approved cfapenier*. or prepackaged fcx.ds ham approved souices <br />Apprwttd water tor dunking, utens I n'xi hard washing will toe prowded in nsy txx«h by the foltowing methods. <br />H Approved bottled water <br />I am prozdng toed that« NOT prepmed hi home L-J Ym Q No <br />All food t» preparttd or>»ile or Is frar. approver! cnmnierctal facilities 0 Yes No <br />Name of taolity ____________________ ___________________Phone ( , ____________________ <br />Address o1 faoily _____________________ <br />I am providrg a booth with the tofcwing: (to protect rny unpackaged feed end food preparation areas tram fiie< <br />(luw fthu the puNic) <br />LJ A booth with walk and ceiling cons’nrcled of «lhor wood, anwas, plastic smlar nurtuilai and fee rrweh n, <br />screen ng ccmpWey enctosiog open food areas It -mII ako have a smooth and cteanab-e Oocr (concrete <br />3VC3S frerr ?he,put4tc'”d BnV’<>''h flf° tKC0F,8hl°' n,ul constructed to sepeinta food and food prqiaralcm <br />0 OV'cr fspeciJy). enrJostrt ire lBf_______________________________