Laserfiche WebLink
Environmental Health DepartmentSAN JOAOUIN <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):1.1 Name of Event: <br />2. <br />Address: <br />Phone: <br />3. <br />5. <br />6. <br />9. <br />Note: <br />TtWEVTNTAAP <br />7. <br />8.er to measure the hot and cold holding of potentially hazardous <br />Yes No <br />1868 E. Hazelton Avenue | Stockton. <br />tHU IM! <br />0V1*1* <br />All food vendors (both for profit and non-profit) aro required to return a signed and completed copy of this chocMst to <br />the festival coordinator three (3) weeks prior to this event i / <br />L_OT>'l (qA n=f<.r.v -7/ / <br />California 95205 | T 209 468-34201 F 209464-0138 | www.sjgov.org/ehd <br />Pag*7c<11 TiMPEVEMM <br />foods during all times of booth operation: <br />lamf . -............................. <br />135’F: <br /> Camp stovo <br /> Double steamer <br /> Electric stove top <br />Examples of potentially hazardous food include: <br />vogotablos. potato salad, eggs, and dairy products. <br />The following is information about my orgamzatlon/business. <br />Na™ a, UoY - <br />5X)i)i€y tkvfr. SAcAAr^^0, ca 9566?------------- <br /> ( Alternate: ( ) ---------------- <br />UNtoUabaaNd^Nantc....^ <br />z r'C'X’* VV1 E <br />I am providing food that is NOT prepared at homo (y Yes No / <br />All food is prepared on-site or is from approved commercial facilities: [y Yes No <br />Name of facility: Uo< k.-rcHC^ Phone: () 5o^QH7H---------------- <br />Address of fanlity: S5oS rAcCu , C A 9 %6?------------------- - <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from s, <br />dust and the public) <br /> A booth with walls and ceihng constructed of either wood, canvas, plastic, similar <br />screening, completely enclosing open food areas. It will also have a smooth and <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify): ------------------------------------------------------------------------ <br />Noto: The only operations not required to provide endosod 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 />^On-eite hose bib that is connected to a potable water source. <br /> Other (specify):_1------------------------- <br />Electricity is provided for my booth's use: H Yjs Q No <br />I am providing an accurate probe “ * ' ‘ <br />providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br />^fstearn table & fids <br />^Other (specify) ClM-ToP Gi’-kl \vn "Tavc/^ <br />meats, Umiles, cooked beans, rice,