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SAN)JOAQUIN <br /> <br />Environmental Health Department <br />Rfirinno A Inv rnnn liffkinninoe A inn' If' A/-1,\1\I <br />I 11-11VI r .#1-AM I I 11- j%.0 la V 1-111a %./ EN %,.7rr r Li VP% I 1%./111 <br />A!! fnnd vPndnrc (hnth fnr nrnfit and nn n-rrnfit) are required tn rettirn a igneel and nnmp!PtPri rsrlpy (-If this nhenklio, tn <br />the festival coordinator three (3) weeks prior to this event. <br />i 01 The Vaiti-t,j <br />The following is information about my orga ization/business: <br />Name of organization/business. <br />Address: kodis <br /> <br />PhnnP• (iff) <br /> <br />Alternate: ( <br /> <br />List food to be sold or given to the public: e,05 <br />4 I am providing food that is NOT prepared at home. Yes E No <br />All food is prepared on-site or is from approved comniepial facilities. Yes 0 No <br />Name of facility: 1-0 60,p4va--C Phone: ( 24°Q) 1,q —'771 <br />A LI (3 tor/X(4,-d A'iL Cvd,/ 101%.+11114 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0 Other (specify): <br />Note: The only 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 />0 On-site hose bib that is connected to a potable water source. <br />[=1 Other (specify): <br />Electricity is provided for my booth's use: Yes 0 No <br />P. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: j:2'es 1=1 No <br />9. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />hotel,rrin troys <br />0 Double steamer <br /> El Steam table & lids <br />LI Electric stove top <br /> 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazetton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 484-0138 I www.sjgov.org/ehd <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />-1. Name of Event: Date(s):