Laserfiche WebLink
Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />1. <br />2. <br />3 <br />4. <br />S <br />6 <br />9 <br />meats, tamales, cooked beans, rice. <br />F-jp* ! e» 11 *tW't si Nr AFT <br />i <br />& <br />Hote: The not reqM«*d jxwcto eMoced tocArts we itKrte nhtdt seC beverages from <br />approved itepenseta. Of prepackaged foods torn oppravad sources <br />13ST: <br />OCafrp stove <br />O Ooutto steamer <br />O EtediK sKwe top <br />1863 E Hapctton Avww | Stockton. Colfomw 9S2QS | T 20940-5420 j f 209464-0'536 'aw-w &wv <br />EHJfWJ Fj^rafil ------ <br />Mote: Exampdee erf poiemially hazardous food todudo: <br />vogeowos, potato salad, ogg». and dairy pcoducu. <br />1 am pKwidaB food that IS HOT prepared al home CR.Ves H No <br />AB food -to. prepared oostto or n ftom approwid cownorcW ladKee: Yes No <br />NanwoftodHy Phono < 1 ___________ — <br />Address <rf taefttr <br />I am prcMdmg • boot) wkh t» totowng: (to protect my urpackaged toed itod tood-pteparafcn aseas from fitos. <br />dust and the putAc) <br />txxtot with wafts and coring eawtructod of either wood, canvas, ptiasbe. snwtar rnoconci and fine mash fly <br />screwnng, comptoteey enctooing open toed anas it w« also have a smooth and deanotte foot (concrvle <br />asphalt dean tarps and smooth wood are aocoplabte) and constructed to sepsroie food and food preparatton <br />areas from foe puUc <br /> Other (specify) ....................................................................................................................... <br />Approved water for dunking, utondl and hand washing wW be ptowded to my boom by the tattowv^ methods <br />§j| Approved betted water <br />|$3 On-Site how M> that its connected to a potobte water source <br /> Other (speerfyj._______________ _______________________________ <br />Etectnctfy « provided for my lxxXh‘5 we. ® Yes No <br />I pm prowling accurate probe tbermomtoter to measure toe hot and coto tioMng d potmUafty ttamtea <br />foods during ai him of booth operator* Si O No <br />I am providing foe foftowrig hot teirperatote cctoHof for toe hot hoktog erf 41 poteroety hazardous feeds above <br />O Siemo & hotel trays <br /> Steam tetteftMs <br />® Other (specify) <br />SAN JOAQUIN <br />C O J N T Y <br />I ’' ■ i , I » » \»1 .. <br />r IftCl i U> - 1&SU <br />Co^toYYfUYYhiA - <br />l^>1^^Tx!ors fl*1** ** pfofi4 iwoprs&i we requited to wtom a signed and complied «w Uw d»c*fc« to <br />jorcansKX riee (j) weeks poor to foa evtrit VricJjt'y <br />t Name erf Evwt. bVLYYCfo»>efs) <br />The fofowng «tnfofmaBoc about my orgateQsatonfowneas <br />Name wgariMtonbusineis Sv-XSA OYyj yv5OY€>______________ __________ <br />***■« — ____________________ <br /> Aftemate <br />Ust toed to be sett or given to the puMe 2CCP. I