Laserfiche WebLink
Environmental Health Department <br />1. <br />2. <br />C/llKCh <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />Date(s): /Qilg <br />__Akryjlf o? -Hit. FVssutMcH-ion <br />St__Stoc-Hon QSZqt, <br /> Alternate: MS") - 'Z/U/6/ <br />SAN JOAQUIN <br />------COUNTY <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) £._ <br />the festival coordinator three (3) weeks prior to this event. <br />1-Name of Event:._J5airrV [Wnru’s <br />[eC!UI/ed t0 return a Sl9ned and comP|eted copy of this checklist to <br />n~V 15 •/'TirvAi /zs+i 1/711 <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: <br />Zr“AVenUe' StOCkton'Ca,if°mia9520p5gIT; 209 468-34201 F 209 464-0138 | www.sjgov.org/ehd <br />06/19/19 9 TEMP EVENT APP <br />List food to be sold or given to the public: /i' pi i i(\ <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: S Yes No <br />Name of facility:-------------------------------------- ----------------------------Phone: £__J <br />Address of facility: <br /> ' toand the pubTc? f0"0Win9: (t° Pr°teCt my unpacka9ed foocl and food-preparation areas from flies. <br />T''"9 const™cted of either wood' camas, plastic, similar material and fine mesh fly <br />9| COn?pletely ®nclosln9 open food areas. It will also have a smooth and cleanable floor (concrete^ <br />areas from the puMc3 S W0°d arS acceptable) and instructed to separate food and food preparation <br /> 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 the following methods: <br />H Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: O Yes No ------------------------------------------ <br />' ^SalHImesb0'*"9 °f haZard°US <br />1 am Providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />S Camp stove Q Sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top 0 other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.