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4/26/2018 MM Vendor Events 3.jpeg <br />SAN JOAOUIN Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Date-s) 1 Name of Event 1 <br />2 <br />Address <br />3. <br />4 <br />5 <br /> Other (speafyy <br />Approved water for drinking, utensil and hand washing will be provided m my booth by the foltowing methodsa <br />3 Approved bottled water <br /> On-site hose txb that« connected to a potaWe water source <br />9 <br />meats, tamale*, cooked beans, rice, <br />1/1https://mail.google.com/mail/u/0/?tab=wm#search/nbminidonuts%40gmail.com/162f9a5e889c3657?projector=1&messagePartld-0.4 <br />:&58 E HazMOh Avenue <br />t Hi; 16-82 <br />oriOtry <br />7. <br />8 <br />Note: The on»y operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Stemo & hotel trays <br />C Steam table 4 tos <br />M Other ispecify) D o nu j V V telk f V <br />foods during an fames of booth operation: E Yes No <br />I am providing the fotfowtng hot temperature control for the hot holding of ail potenbaPy hazardous foods above <br />135 F <br /> Camp stove <br /> Double steamer <br />Cl Eiectnc stove top <br />Stocktoc Ca'iforna 85205 l T 209 458-3470 | F 209 464-0138 w»vw S.-CC'd com <br />pHfl- T n* U ! 'IMP t VI N1 <br />The foMowing »(ntormabon about my organizatxxiTxjsmess <br />buW hmr..xJkiuii. Jz&uaik <br />® A booth with wails and ceisng constructed of either wood canvas, ptasbc. similar matenai and fine mesh fly <br />screening, complete^ enclosing open food areas II wtK also have a smooth and cleanable floor (concrete <br />asphaft clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />Noto. Examptos of potontisOy hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />M food vendors (both for profit and non-profit) are required to return a signed and completed copy of th® checto*t to <br />the festival coordinator three (3) weeks poor to th® event <br />I am providing food that is NOT prepared at home 53 Yes No <br />M food <s prepared on-site or is from approved commercial fac-irties £2 Yes [j No <br />Name of tacrtrty N Q b-> L Phone ( ) . <br />Address of facility <br />I am providing a booth with the toxowing (to protect my unpaoaged food and food-preparation areas from ftes <br />dust and the public) <br />Name of organzationifousiness <br />Phone (SIC ) A/*/ Alternate (^ |0 ) <br />L«! food to be sold or given to the pubic H } i i) i OoHuis <br /> Other (specify) <br />Electricity is provided for my booth s use E Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous