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Environmental Health Department <br />-rffRannin A M/ rnnr, wckinncile A rim If A1-1/II I L MI U%.0 IFS.P1 IN I %.1 Li V I- IVLi%../ 'r V I-1%#" I Iv 11 <br />All fnnoi vPhoinrc (hnth fnr nrnfit nr1 hnh-nrnfit) rAqi uirrl tn rPti irn inr1 nrl nnrn,olg,tPri <br />the festival coordinator three (3) weeks prior to this event. <br />I. Name of Event: ka/GI th -riv VaLle/y <br />2. The following is information about my organization/business: <br />Name of organization/business: &PA <br />Address: <br />rnpy this rhAnk!it. to <br />Date(s): 0 ii0 60/--f <br />Phone : 6141 Aitp,,te, <br />3. List food to be sold or given to the public: <br /> Rvbs <br />4 I am providing food that is NOT prepared at home. Yes E] No <br />All food is prepared on-site or js from approved commercial facilities: Yes El No <br />Name of facility: kocti Phone: ( ,31/9 <br />rlcl SA I 1 I II IL <br /> <br />\IX /5WO A <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 />77 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 />El 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 />)2rApproved bottled water. <br />IE On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use: es No <br />I am providing an accurate probe them om rto measure the hot and cold holding of potentially hazardous <br /> <br />foods during all times of booth operation. Yes [El No <br />I am providing the following hot tempera ure control for the hot holding of all potentially hazardous foods above <br />135°F: <br />zZrcterfic hotei trays <br />lE1 Steam table & lids <br />Other (specify) <br />El Double steamer <br />El Electric stove top <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />15:1PR Avenue! Stockton California 95205 T 209 468-3420 F 209 464-0138 www innv nrniPhd <br />El-ID 16-02 Page7 of 11 TEMP EVENT APP <br />06/29/2023