Laserfiche WebLink
Environmental Health Department <br />1.1. Name of Event: <br />2. <br />Address: <br />Phone: <br />) <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />__________Date(s): <br />SAN JOAQUIN <br />-----COUNTY------ <br /><s..„Greafn?$$ grows Aere. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Sr *0 3 C°Py °f tWs to <br />PhiKppuT. n^w. <br />O On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth’s use: M Yes No----------------------------------------------------- <br />' ,he hot and “ld h0ld^ °< «y hazardous <br />1 TssT1*9 lhe f0ll0Wln9 hOt temPera,ure con'ral for the hot holding of all potentially hazardous foods above <br /> Camp stove Q Sterno & hotel trays <br />® Double steamer Q steam table & lids <br /> Electric stove top Q other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />NOte: AnnrnuTrtXonfrX "Ot provide enclosed b°°ths 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 />The following is information about my organization/business: <br />Name of organization/business: THg. GlTtjo CAlJO Oft ' <br />WT s, TiyM) 64-143, (4. Ts 27) <br />)-^^M 2-2-1__________________ Alternate: ( <br />List food to be sold or given to the public: lj/U¥)p1/2 <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: [^Yes No <br />Name of facility: ------------------- --------------------------------------Phone: {)_ <br />Address of facility: " <br />' ^sTand the publte)11 f0"°Win9: unpacka9ed food and food-preparation areas from flies, <br />areasfromtee pX Sm°0,h W00d acceptable> and constructed to separate food and food preparation <br /> Other (specify):______________ <br />EHD ^2 Hazelton Avenue 1 Stolon, California 95205 I T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />07/3/17 Pa9e 7 °’11 TEMP EVENT APP