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2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Environmental Health Department <br />0^5? ~ ^3^ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />dAN JUAUUIN <br />COUNTY■ <br />™09 Hazelton AveriL,e I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd com <br />n^6’02 Page 7 of 11 TEMP EVENT APR <br />thlSi^nd°rSa-b°*th pro™ and 2on’Profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business:^)^ f bf K <br />Address: <br />Phone: 6 T Alternate: ( ) <br />/o00T0^eT0^0r)9T«lhI?Ubl!£ (TftHV I <br />C 12 • n ex cm s ( ) r“Cl^S/ 7 7 7 <br />I am providing food that is NOT prepared at home: C/fYes No <br />All food is prepared on-site or is from approved commercial facilities: B^s No <br />Name of facility: Q J Phone: (/aS) <br />Addressoffacility:fl2<<^^\4 O <br />1 ^r0V!?,u9 a bl?.°th With the fo,low*n9-' (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />0A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fiy <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areasfromthe^pubtic311^ Srn°Oth W°Od are accePtable) and constructed to separate food and food preparation <br /> 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 />□"Kpproved bottled water. <br />LQpfi-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes No <br />1 ImdTdTinn aTtirnTTh the™omr^,0 measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: es No <br />1 T£r°viding the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br />O Camp stove [D^terno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.