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9/8/25, 9:19 PM lmage_250905_172744. jpeg <br />Environmental Health Department <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />Phone: (1 <br />5. <br />6. <br />9. <br />Avenue I Sfookton, California 052G5 | T 209 438-3420 | F 209484-0138 { <br />https://mail.goagle.com/mail/u/3/#inbox/QgrcJHsbjCmDKPQxNdfzLSntjqXNBGSbSLQ?projector=1 1/1 <br />7. <br />8. <br />Oatefs): /O <br />3 <br />mean, tamales, ooqM feww. <br />SAN JOAQUIN <br />------COUNTY------ <br />CA <br /> Alternate: ( ) <br />List food to be sold or given to the public: VS P<JTC C DTRM <br />I am providing food that is NOT prepared at home: ETYes No , <br />All food is prepared on-site or is from approved commercial facilities: 0Yes Q No <br />Namecffadltty: <br />Address of facility:. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from fifes, <br />dust and the public) <br />E'Abooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and definable floor (concrete, <br />asphalt, dean tarps and smooth wood are 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 seH 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 />ED^pproved bottled water. <br />Q'On-site hose bib that Is connected to a potable water source. <br /> Other (specify): x__________________ <br />Electricity is provided for my booth’s use: Yea No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially havantat m <br />foods during all times of booth operation: Yes No <br />1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />13S*F: a,i" <br />DCampstove Stemoft hotel trays <br />□Doubtesteamer Steam table & lids <br /> Electric stove top Other (specify) <br />Nq*k ExamplM of potentially hazardous food Include: <br />vegetebtes, potato sated, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Ms sZTt0 rB,Urn 3 8lflned and “mpleted Of8,19 d’“W1,rtto <br />1.Name of Event. <br />IThe following is infun nation about my organization/buainess: <br />Name of organlzation/business: CaTTCTtO C JVUtW CoIaJX^)^ <br />Address: -X Gbrh)ST <br />fgoVrwqfcjhil ■