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< <br />Environmental Health Department <br />2 <br />3. <br />4 <br />5. <br />6. <br />9. <br />moats, tamales, cooked beans, rice, <br />7. <br />8. <br />SAN JOAOUIN <br />COUNTY <br />_ Date(s): ^ 7 <br />_-___/ <br /> Alternate. ( ) <br />ehd?6-o2 HaZelt°n AvenUe 1 Stockt°n. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov org/ehd <br />06/29/2023 Page 7 of 11 TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordLtorXee^S) weeksp'dor to this evStt^ retUm 3 S'9ned 3nd completed copy of this checklist to <br />1. 1. Name of Event: /- <br />The following is information about my organization/business: <br />Name of organization/business. 'Tcp Cq.l'er^ <br />Address: ‘/J// A <br />Phone: (^0? ) <br />List food to be sold or given to the public: . <br />I am providing food that is NOT prepared at home: [pTYes No <br />All food is prepared, on-site or is from approved commercial facilities: 0Yes No <br />Name of facility: A. Phone: (Z^ f) 'S O 6. <br />Address of facility:____________________ 1 --------------- <br />' TusTaOnd the“ ,0"°Win9: (t° Pr°teCt my unPackaSed food and food-preparation areas from flies, <br />□ Other (specify):11C Y" <br />approved dispensers. Wh'Ch SB" beuera9es ,rom <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^'Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): , <br />Electricity is provided for my booth's use. [£ Yes [ 4o " - -------------------------- <br />' holding of potential^ hazardous <br />1 s1r^rFovld'r19 following hot temperature control for the hot holding of all potentially hazardous foods above <br />Eh vdmp stove Q Sterno & hotel trays <br />[7 Jouble 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.