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R’S APPLICATION <br />[JNo <br />6. <br />♦ in <br />“nr <br />[JNo <br />the hot and cold holding of potentially hazardous <br />[^es [JNo <br />ntrol for foe hot holding of all potentially hazardous foods <br />[ ] Electric stove top <br />[ ] Other (specify): - -------------------- <br />slude: meats, tamales, cooked beans, rice vegetables. <br />SAN JOAQUIN COUNTY <br />ENVIORMENTAL HBALTHDEPARTMENT <br />1868 Eart Hazriton Avenue, Stockton, California 95205 <br />Baaineas: (209)468-3420 <br />. v,|l->tT»j,ofrHMmrK ifiir—»«» i. : <br />4. I am providing food that is NOT prepared at home: KJYes [ ]No <br />All food ia prepared 5^5$/ <br /> 5. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and foe public) <br />« A booth with walls and <?ei1iqg coMtnicied of mfoer wood, canvas, plastic, similar material and tine <br />me^h fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from foe public. <br />[ j Other (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 foe following <br />methods: <br />M Approved bottled water. <br />On-site hose bib that is connected to apotable water source. <br />[] Other (specify): <br />7. Electricity is provided for my boofo’s use: fG Yes <br />8. lam providing an accurate probe thermometer to measu <br />foods during all time of booth operation: f “ <br />9. I am providing foe following hot temperature control <br />above 135 degrees Fahrenheit: <br />Camp Stove [^Double steamer <br />[] Stemo & hotel trays [] Steam table & lids <br />Note. Examples of potentially hazardous food incl— <br />potato salad, eggs and dairy products. <br />TEMPORARY FOOD VEN <br />AH food vendors (both for profit and non-profit) are required to return a signed and completed copy of this <br />checklisho foe festival coordinator three (3) weeks prior to this event. <br />1. Name of Event:^^ _ DateO):^'^^ 2^. <br />2. The foUowing is infonnatiito about my organiration/busmess: x q <br />Name of or^mzation/business: ~ <br />Address: 4^*X _____________—.............. ..............7------ ------------------- <br /> Phone-J<7 7^7-5^/- j ---------- <br />3. List food to be sold or given to the public: ---------------