Laserfiche WebLink
Environmental Health Department <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />SAN JOAOUIN <br />------COUNTY - - <br />J35°F: <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of <br />vegetables, potato salad, eggs, and dairy products. <br />eho im2 Ha2elt°n Aven‘Je ' Stolon, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />06/19/19 Pa9e 7 Of 1 ' TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three^S) weeta piK t0 3 S'gned and comP,eted copy of this checklist to <br />1. Name of Event ---------------------------------------------------------—=__________Date(s): dHAfcV-Oct <br />The following is information about my organization/business: <br />Name of organization/business: S Cf flYlafchuC<U RiKkoA <br />Address: g-9A3 _______ J <br />Phone. (S1D ) -^5^------------------------- Alternate: pg l°j j^-Q’aoo <br />LqX rT50Jdi , Qnt'onnn^ <br />YYuwq ^teo^^jYnoZTxxreUqSVi'Glcs j’Z.Ucc^ni.hb+Joar min- .jjj-------77 U74I am providing food that is NOT prepared at home: 0 Yes No 9A / YYl A > co f A dbg j <br />All food is preparedon-site or is fromapproved commercial facilities: Yes No <br />Name of facility: S phone; <br />Address of facility. >fc\vd <br />' and the pu^ 'he f0"0™91 pr°^ unpackaged food and food-preparation areas from flies, <br />areas tom the puMc3 * W°Od acCeptable) and “"stnjcted to separate food and food preparation <br />Other (specify); t^AQ^O t \g_ <br />N°te: ™LOPeratiOnS nOt reqUi?d t0 pr°Vide encl0sed b00ths 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 /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />'M Other (specify): On (-poj VyAiX-er <br />Electricity is provided for my booth’s use: Yes No - ---------------------------"— <br />1 J!in/CCUr£?! Pr£be the™or?®ter to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation:^} Yes Q No y <br />' Viding the fol,owing hot temperature control for the hot holding of all potentially hazardous foods above <br /> Stemo & hotel trays <br /> Steam table & lids <br />Mother (specify) CooM b o^f - <br />potentially hazardous food include: meats, tamales, cooked beans, rice,