Laserfiche WebLink
Environmental Health Department <br /> <br />Date(s): <br />2. <br />KT.) 6/ <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />7. <br />8. <br />www.sjgov.org/ehd <br />TEMP EVENT APP <br />event. 3 S'9ned and completed “PV of ^is checklist to <br />SWV i~------------Date(s): I 23 <br />n3261*0" AVenUe 1 St°CktOn'California 95205gl _T 209 468-34201 F 209 464-0138 | <br /> Alternate:( <br />List food to be sold or given to the public: kz <br />I am providing food that is NOT prepared at home: Yes No ' P F 4L Ua <br />All food is prepared on-site or is from approved commercial facilities- 0. Yes H No <br />Name of facility: Kdckm .Phone- / 7 6 Q - <br />Address of facility: J C ~~-------------- <br />' By **”"» «° bod and tooLpreparation areas from fcs. <br />screening, completely enctoshg9open'food Ireas"1'”S'^is^h''38' Pla5l'C’ I'™13'rna,erial and ,ine ™»h Uy <br />X^eXX3"'1 “b WOOd 3re aC03P,ab'a’ a"d '» <br />0 Other (specify): .BspH >5 <br /> <br />Note' ",0S3 “hich b"'er39es fr”" <br />Approved water for drinking, utensil and hand washing win 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 />Other (specify): KT U->£Xx f Aa <br />Electricity is provided tor my booth’s^ use: ["1 Yes [xLNo v—»--------------------------------------------------- <br />Holding c potentiaily hazardous <br />I am pmwdmg the following hot temperature contml for the hot holding of ail potentially hazardous foods above <br /> Camp stove D sterno & hote| trays <br /> Double steamer 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 />SAN JOAQUIN <br />-----COUNTY <br />1 -,t;- Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AH food vendors (both for profit and noreprolit) are required to return <br />the festival coordinator three (3) weeks prior to this <br />1- 1. Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: * N.Kt-S <br />Address: —-5 KkC.ZtYA-A 0 f\ <br />) <br />meats, tamales, cooked beans, rice,