Laserfiche WebLink
<br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />7. <br />8. <br />ehd8-02 Hazelton Avenue j Stockton, California 95205 | <br />0773/17 P':~ <br />Environmental Health Department <br />>_______ _ _ <br />—g7 S;?y-7 <br />Alternate: ( 2^1} "7 4> SZ) <br />. - I CJL <br />PaqUL n°9 468'3420 I F 209 464-0138 | www.sjcehd.com <br />TEMP EVENT APP <br />-Sou, <br />SANJOAOUIN <br />------COUNTY------ <br />2--'UY' '-■''tTiM-.'Ts arcivs hsrtL. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />10 — 8 *eda„d compfeted ecpyof ,his che«slt0 <br />1 ’Name °f Ev8nt Date(sl: 7/^Z/e <br />The following is information about my organization/business: <br />Name of organization/business: A TL Q' <br />Address: <br />Phone: ( Q , <br />List food to be sold or given to the public: *7 <br />I am providing food that is NOT prepared at home; 04es No <br />All food is prepared on-site or is from approved commercial facilities: 0Yes Fl No <br />Name °f faci'ity: —___ ________Phone-Z___1_ <br />Address of facility: _ _— ------------------ — <br />' 7uSd inhe W^,,’the (l° Pr°tK1 w un')aoka9sid foodand food-preparation areas from flies, <br />asphalt, dean taps and "3 »oo3 ™aSpC te> Xia?- »d oteanable floor (concrela’, <br />areas from the public. acceptable) and constructed to separate food and food preparation <br />0Other(specify): SZ CX <br />Note: ,tee <br />Approved water for drlnklna, utensil and hand washinp M 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 />pother (specify): <br />Electricity is provided for my booth’s use- Yes Qllo ---------------—---------------------------------------- <br />' foXX\T™ ,hC “ ““ hazardous <br />' a^5PrFwld,n9 the fo(10WI"g hot temperature control for the hot holding of al! potentially hazardous foods above <br /> Camp stove QJ stemo & hotel trays ( <br /> Double steamer Q Steam table & lids <br />O Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.