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1 <br />i a 7J5 <br />2. <br />Address: <br />Phone: <br />3. <br />4 <br />5 <br />- ^PCWVjM- yo . <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />LJ Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />meats, tamales, cooked beans, rice, <br />7 <br />8 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />SAN JOAQUIN <br />■^COUNTY <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):_ . _________ <br />Electricity is provided for my booth's use: H YesJS'fto <br />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: O Yes^No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Camp stove <br /> Double steamer <br />Q Electric stove top <br />Environmental Health Department <br />TEMP°RARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and n <br />the festival coordinator three (3) weeks prior to this even^ ,0 rOtUm 8 S'9ne<J and completed copy of this checklist to <br />The follow,,^ is lntomatran about my otganl?alionft)us.nB88: <br />Name of organizatiOfVbusiness; ‘’ t>KGU- ........................., <br /> <br /> Alternate: (^iS^l) (_6>( O ' <br />(pre. - <br />List food to be sold or given to the public: Q ODuCS, OAtP, . <br />I am providing food that is NOT prepared at homeij^Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: Phone: /7'SO~ iQlpO <br />Address of facility: C0 A \ V* A\CU'Q&\ (ji (oO \ ‘SV V \ <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 />^S^Other (specify):( Q X t <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.