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3CKx>& 30'1 <br />k <br />F .nvironmontal Health Department <br />1. <br />Phon®, <br />3 <br />4. <br />5. <br />iiie.its tanukis, cooked beans, rics, <br />7. <br />8 <br />‘ J OPie- fspecify). - <br />^>te Tn.- only operations not required Io provide enclosed booths aie those which sell beverages frorn <br />i-jprove I dispensers, or prepackaged foods from approved sources <br />App’ i/ed /rate* for drinking, utensil and hand washing will be provided in my boolh by the foBowinq methods <br />SAN JOAQUIN <br />— CODNTV <br />A« fcvd wwtoni iTx'Hi <br />the coordrm 'k ' ~ <br />^7%/- pptoved ootfled water. <br />i hosr. •; i, that is C0finc< ted to a potable water source <br />[ C ”, er specify; <br />iiy i- pro/iod for my booth's use LjYes| | No <br />P”>..':nq a» accurali probe thermometer to measure the hot and cold holding or ootentiatlv hazardous <br />. <;. i”. .:ii . of booth operation; ( 1 Yes [. i No <br />' »hF f .1 w «.j hot temperature control for the hot holding of ill potentially h;> vdous foods tbove <br />135T: <br />< • p Mow Sterno & hotel trays <br />dbiHMr | J Steam tuMe & lids <br />1 3 EtaoW. stove top | J Oihur (epeafy) <br />Noir, examples of potmih.illy hazardous food Include <br />vegataMee. potato salad, <;ggt», .ii>d dafty pioducts. <br />It MPORARY I OOP VFNnOR’S APPLICATION <br />P1o rrquitrd h» (■•lum f» HI”-I and t'.rnp!”!' d copy of IM to <br />thmer.lK’ '■ I* ’ ” tn”, <br />Th* fotkiwino « mtoim”on about my orQantretion/bu^nass <br />N.»m» ofonpent-ation'hi^ineis- <br />k <br />/ vt-'“ue| ,-hiQiniu‘p12U!>| I 2uu.ihtt VIA) I f. 209 464.0138 | www.a|cehd.com <br />' I IEMP EVENT APP <br />e^h/c’ <br />Ad«« I'tX? tJ- fWurtJ- <br />5 Alternate f <br />IMMk>oMnttteuHte <br />t > k. ^t/CSA^r I (a ( <br />■ - •. that ifiNOJ prepared at home^f^Yes I J No <br />. ’ — <■■ -s‘le or is from approver! commercial facilities Mo <br />No-',. . facay ■. Phone-L —)-------- <br />Add-ess of faciirfv: ___________ _______ <br />• •ic 3 booth with the followfng (tn protect my unpackaqed food and food-preparation areas from ies <br />dust end the public) <br />• mv wa'ls and ceiling constructed of eittier wood, canvas, plastic, similar material and fire mesh <br />• s' . ompietely enclosing open food areas It will also have a smooth and cleanable floor (concrete <br />. -1 ...4i tarps and smooth woorl are acceptable) and constructed to separate food and food preparation <br />areas- from the public