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/ ' <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.I.Name of Event:<L <br />2. <br />Name of organization/business: <br />Address: <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br />6. <br />food Include: <br />K3K 7. <br />k)k 8. <br />NJ k 9. <br />F 209 464-0138 | wvw.sjgov.org/ehd <br />TEMP EVENTAPP <br />( <br />List food to be sold or given to the public: <br />The following is information about my organization/business: <br />\0T<\£ or. <br />^>r . \ v\<> <br />ehd?6^2 Ha2eiton Avenue | Stockton. California 95205 | T 209 468-3420 I <br />°B/19/19 PugcTofll 1 <br />AH food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />< QcX. > Date(s): <br />SAN JOAQUIN <br />' : ’ .. ’ ......-COUN“Y <br />Grcnfnrs: Fcrr <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: QVes No <br />Name of facility: M L^X^-Rhone: ( G X.A <br />Address of faciljty: Sv. , { g C_A s'< <br />‘ TJJTnH tw9 3 the fo,,owin9: (to Protect n,y unpackaged food and food-preparation areas from flies, <br />□Lisi ano tne public) <br />and ,Ceil'n3 const"jcted °f either wood. canvas, plastic, similar material and fine mesh fly <br />screening completely enclostng open food areas. It will also have a smooth and cleanable floor (concrete <br />aSL tomTe p^ic3 * aCCepteble) and corlstnjt:ted to separate food and food preparation <br />O Other (specify):_______________ <br />Note: The only operations not required to provide enclosed booths are those whirh «»n ho,,Qr-, <br />approved dispensers, or prepackaged foods from approved soured beverages from <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 Q No ' ------------------------ - <br />' h°‘ and ““ h°,din9 °f bazardoos <br />I am proving the fotlowing hot temperature eontro, for the hot holdmg of al! potentiaUy hazardous foods above <br /> Camp stove £] stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />N°te: °f P°,en,ial|y hazardous f„„„ <br />vegetables, potato salad, eggs, and dairy products.meats, tamales, cooked beans, rice,