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I <br />Environmental Health Department <br />i <br />i <br />2. <br />Phone: <br />■kA3. <br />4. <br />5. <br />6. <br />9. <br />I <br />1868 E Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | <br />EHD1M2 P«O»7oni TEMP EVENT APR <br />07/&VM24 <br />SANtJOAOUIN <br />-----COUNTY------ <br />GrcnlneM grow? here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />signed and completed copy of this chockBst to <br /> Date(a):(0) I — <br />AH food vendora (both for profit and non-profit) are required to return a <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1. Name of Event: _ lAl SfCekW c H Ou <br />o <br />The following Is Information about my organlzallon/buslness: <br /> Name of organlzatlon/buslness:. Le- Qv\-V ~ <br />Ad^ss: <br /> { 6 TO Alternate: ( 9 0 ? -------- <br /> <br />List food to be sold or given to the public Al Q'CA P&&/_ <br />I am providing food that Is NOT prepared al home: Q^es No <br />All food Is prepared on-site or Is from approved commercial fadlities^H Yes No <br /> Name of facility:Phone. (------1---------------------------- <br />lampro^dln^akioth with the following: (to protect my unpackaged food and food-preparation areas from files, <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar njajeital <br />screenino comoleteiv enclosing open food areas. It will also have a smooth and cleanable floor asphalTdean l^rps Xfo smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Ddher (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 />^^fApproved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br /> <br />7e; the ho. of potenW haz^ <br />I M^°ng W hot holding of all potentially hazardous foods above <br />135T: <br /> Camp stove Stemo & hotel trays <br />O Double steamer D Steam table & lids <br /> Electric stove top p^Other (specify) (rUCA^ <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.