Laserfiche WebLink
2 <br />CO <br />cA <br />Phcwu* <br />3 <br />4. <br />5 <br />6. <br />a <br />meats, tamales, cooked beans, rice, <br />kVenuel <br />7. <br />8. <br />135T: <br />PI Camp stove <br /> Double steamer <br /> EMricetovetop <br />SAN JOAQUIN <br />C Ol INT V <br />ft <br />wnplee of potentially hazardous food include: <br />mtabtee, potato salad, eggs, and dairy products. <br />. California 952051 T 209 468-34201 F 209464-0138 | www.s|cehd.com <br />PagaZofll <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />AU wndcwi (both fix iMnfit ihwi |»n«f4|) »<•» inqni'Att ti» •chirn -< Mrir.H>| <br />t**^*'"’*'*' Ihir- —' <br />1 <br /> Other (specify):_________________________________________ <br />Electricity is provided for my booth's use: 0»es Cl No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />E„vlronm.nt.l He.® <br />C”*** I” tbfe* <br />Ey$ion ffit/Aic <br />Th* •filormntkin nbotrt rny <br />Nanx* eV orvjanirnirontoirsmit!;Coffee <br />Addmn C f (/Alfcf <br />Q0<f)<PG3-L4jT_ ______Allewn*irt« { ; <br />L»1 food to be told a Qiwn to Ihn public Cold/lh\ '>rv}c/jPo^> <br />I am providing food that ts NOT prepared at home: [^Yes / <br />All food is prepared on-site or rs from approved commercial faciMvog |/| Ye*i f 1 Ho <br />Nwne ol todlfty.Phone [] <br />Address of lacHfty:______________________ ___________________________________________________ <br />I am providinfl a booth with the foflowing: (Io protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />L/f^booth wrth walls and ceiling constn^ctcd of either wood, canvas, plasbc. similar material and 'me mesh fly <br />screenr-ng, complefefy enclosing open food areas. It will also have a smooth and cleanable fVcor (concrete, <br />asphart. cfosn tarps end smooth wood nro Acceptable) and constructed to sepurato food one food preparation <br />jvwui from the public. <br />[ZJ Other (specify). <br />Note: The only operations not required to provide enclosed booths are those which sell beverages trem <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved wafer for drinking, utensil and hand washing will be provided m my booth by the tottowmg methods <br />O Approved bottfed wafer. <br /> On-sife hose bib that is connected to a potable water source. <br />of fhl'i chocKJint Io <br />fam/ <br />fH.trMnj - f—