Laserfiche WebLink
Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />tamales, cooked beans, rice, <br />7. <br />8. <br />meats, <br />SANJOAQUIN <br />'' -------COUNTY—-■ <br />Greatness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />' ) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks poor to this event. <br />All food vendors (both for profit and non-profit) <br />I.Name of Event: fiW S <br />The following is information about my organization/business. <br />Name of organization/business:——-------------------------------------------------- <br />p.d w ----------- <br />Phone- ( ) Q-M-W-^02-1---------------- Alternated )-------------------------------------- ------- <br />List food to be sold or given to the public: ------------------------------------- <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: Yes No , / <br />Name of facility: C M -------------- <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood canvas, Pla^similaj <br />SaCsZ;?cieX-d" Xd a^a^bie)^constructed to separate food and food preparation <br />areas from the public. <br />W Other (specify): C/lLVW l/C'^ (Tl ----------------------------------------------------------- <br />Note: The oniy operations not required to provide enclosed 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-site hose bib that is connected to a potable water source. <br />! "ding hot bolding of aU potentiaHy hazardous foods above <br />135°F’ <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top O Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | ~i-hd.com <br />. . _ Hacje • oi • i