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Environments HeaSth Department <br />1. <br />Oct 4 and 5 Date(s): <br />2. <br /> <br />Address: <br /> <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />SAN JOAQUIN <br />CO UN" V <br />( 209 ) 3212707 ... 4 ,' '-----------------------------— Alternate: ( ) <br />List food to be sold or given to the public: buter cook'es. brazilian fudge, cupcakes <br />The following is information about my organization/business: <br />Name of organization/business: OELICIOSO <br />2280 Emory court <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this <br />1. Name of Event: <br />EHO® .02 Ha2el,0n Avenue 1 Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 | www.sjgov.org/ehd <br />..... . Pano 7 r\i 11 ® <br />afj event^ retUm 3 Si9ned completed C0Py of checklist to <br />Manteca Pumpkin Fair <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: 0 Yes No <br />Name of facility: DELICIOSO CFO address same above Phnna- r 2093212707 <br /> Address of facility: 6 -------------------------- - <br />' ™nd ihe f0"0Win9: (t° PrOteCt my “"P^Sed food and food-preparation'areas from flies. <br />ennrlT<n9 COnSt™c,ad °f either wooci' ^nvas. plastic, similar material and fine mesh fly <br />asphal clean tarns00d " W'" a'S° have a sm°°,h and c,eanabte (“ncrete <br />X from the pobHc W00d aCCeP‘able) and constructed td sePara,e food a"d PWon <br />prepacked food, made in CFO address <br /> Other (specify): _____________ <br />Note: »pro0± d0Za'“nS nOt reqd?d t0 provide enclosed b°°ths are those sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. y <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the 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 provided for my booth’s use: Yes No -------- <br />' food^rK ’he hOt and C°ld h°,dina °f P°ten«a"y <br />' aim35Tld,n9 the fO,l°'A,in9 hot temPerature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top Q other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.meats, tamales, cooked beans, rice,