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DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A <br />SANJOAOUIN <br />—CoUNTY-- <br />\ , C., eolnvs5 gi (1w s here. <br />REC-008 <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />Al! toed venders (both ler profit and non-prolit) are required to return a signed and completed copy of this oheast to <br />the festival coordinator three (3) weeks prior to this event,- <br /> <br />1. <br />f;t4ettre_of_Evert atte) <br />(.? \<_, Date(s) 11U I 2.-4k <br /> <br />2, The following Is information about my organization/business: <br />Name of orpnizatIon/buslness: 12._.0.--(-- ,IN. <br />%eilrWs: 52 iff 1,-L Jt 157s2-0(-,' --S6ln tri-}AicTAScA 1 CA 141 (A. <br />Phone: 2.-CY1 —(e)2=1 -" (0 CnI Alternate: <br />List food to be sold or given to the pubilo & a m (---y__=f4f-P NV)S i —irk -ty4laskisLt <br />i am providing food th NOT prepared at horn , <br />All food is prepa t t agr ,iris from approved commercial facilities o <br />Name of faciffly: <br />Address of facility: <br />1 am providing a booth with the following: (to protect my unpackaged food arid food-preparation areas from tiles, <br />dust and the public) <br />(.1E booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly 5 <br />ing, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />[lather (specify): <br />Nate: The only operations not required to provide enclosed booths are those which sell beverages i r130M *Proved 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 />pproved bottled waler. • ' <br />TTn-site hosecbib Ili& is corn eel <br />Phone: <br /> <br /> <br />a <br />her (401y. <br />tTricIy IS f?09.1.0.0•fot,mylppplh 13.1.1a <br />I am accurate probe the <br />foods of booth operatlo am providing l:tho ofloM'ig <br />k _ 0_, • k Lot Scknitt —z•e_C'. surerl Wand cold holding ot potentially hazardous <br />rig 01 all potentially hazardous foods above <br />larnRP le)prO <br />)oub)A Ste <br />Note: Ekemp etfr: <br />vegelobleflo <br />1868 E, Hazelton <br />EN) 16.02 ' P6/19.19: <br />'04X-Mves-Q-. oyo-rc,Oey , &\-tv-c_ <br />1\1\ 1 c..\aa-4-NnoVs\--Ls <br />meats, tamales, cooked kiet". <br />.F 203 464-0138 I www,slgoy,org/ehd <br />TENIP EVEiNfro,p.