Laserfiche WebLink
Environmental Health Department <br />1 Name of Event Date{#) <br />2 <br />Phone <br />3 <br />4 <br />5 <br />6 <br />9 <br />meats, tamalM, cookad beans, rica. <br />Scanned with CamScanner <br />7 <br />8 <br />SAN JOAQUIN <br />COUNTv— <br />CS> , <br />------^4^3 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> On-site hose txb that is connected to a potable water source <br /> Other (specify) <br />Electncity is provided for my booth s use: EfYes No " ------------------------------- <br />I am providing an accurate probe thermometer to measure the hot and cold hoidinq of potentiaHv hazardous <br />foods dunng all times of booth operatjon.^^es O No <br />I am providing the following hot temperature control for the hot holding of an potentially hazardous foods above <br />135T <br />\Q-Camp stove Sterno & hotel trays <br /> Double steamer Steam table & bds <br /> Electric stove top O Other (specify) <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Al' food vendors (both for profit <br />me festival coordinator three (3) <br />1 <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www sraov org/ehd <br />EH0 1S-0.’ PW.r«i1 TEMP EVENT APT'ovnoon <br />lam providing food that is U2I prepared at home [^Yes No <br />...j or is from approved commercial facilities ©"Yes O No <br />QO^-O^ 62 /AC00601^X Phone (3^) 2^1-6 0)0 <br />— 1 00 RtA/n <br />booth with the following (to protect my unpackaged food and food-preparation areas from flies. <br />All food is prepared on-site <br />Name of facrfrty <br />Mdress of faatrty Ruv C? £ 6^ <br />dust and foe ^jbl^ fol,o*1nQ (to Protect my unpackaged food and food-preparation areas from flies. ' /? Avh o. <br />H <F v ^3 <br />scree^^t^ni^Hv^^'1^ cons,,?cte<1 of wood canvas, plastic simiar material and fine mesh fly <br />asphalt dean tar™ areaS 11 al$o a sr™X)th and cieanabte floor (concreteareas ^^ pXec acceptab,e) and to ^Parate food and food preparation <br />L J Other (specify). <br />A Lv O 2 76 <br />Alternate (91S) 5^654-1 q- <br />V(\d.c\ p^wj <br />Nou: - <br />Approved water for dmking, utensil and hand washing wll be provided m my booth by the following methods: <br />l&Approved bottled water <br />and non profit) are required to return a signed and completed copy of this checklist to <br />weeks pnor to this event <br />V S jyiy _____________ <br />Yhe following is information abort my organuatiorvbusiness <br />Name of orgamrabon/busmess {jlftv/Y\)i JunJc7(o<M <br />A<Wrf” - 21 oo \ siy-j vAvlev <br />Ha-5) 2-Tl -6oio_________ <br />List food to be sold o< given to the pubkc $ U (