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SANAOAQUIN <br />COUNTv <br />Environmental Health Department <br />-rutionnrn A Inv, me-New ii elkIrit1117110 A InT11 Ir. A "19"11,1 <br />I L..1V11 %.1111`111 I r ‘,..M.1L1 V 1-111 Lila *.) ?r r L.Mor1 I Iva III <br />All frvIr! vPnc!nrc (hnth fr)r pmfit P.nri rrn-prnfit) qrP P-qiiirPr! tr rPtiirn CignPri Pnri rrIrntp!PfPf1 nnp±,/ rf thic nhPnklict tr) <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: 1R ealj 141 -flit 1 /4,11 <br />The following is information about my organization/business: <br />Name of organization/business. 41144.40's Teieu-s <br />Address: <br /> 109 ,e i)vvizief gt: Pro a4--rtrY1 CA- <br />Phone: (2()&1 AltPrnatp. ( <br /> <br />List food to be sold or given to the public: fre-AJC fruie9'-5 <br />4 I am providing food that is NOT prepared at home>E'-Yes E No <br />All food is prepared on-site or, is from approved commercial facilities. Yes 01 No <br />Name of facility: LJS-t 6,--qe, -Fahmi phone: (A).? )3&e? " .927 7 i <br />AC/I C/IC:3G of facility: 4/ 3 P. Lvait--&-ei 69--. Agel; ce't <br />5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust nd the public) <br />A 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 />E Other (specify): <br />Electricity is provided for my booth's use: Yes 0 No <br />I am providing an accurate probe thermornete to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: es E No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />1-1 CarrIp stove sterno 9 hotel trays <br />['Double steamer 10 Steam table & lids <br />E Electric stove top 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. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www,sjgov,org/encl <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />06/29/2023 <br />Date(s): 0 1/01R/y