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SANAAGlJlN <br /> Envirunmental Health Department <br /> TEMPORARY FoOC7 VENDOR'S APPLICATION <br /> >=j'�^d rrf <br /> AA lord YVIVIC"1""1""to Fern rr^M nM prdAl arm rearvM r0 rrtrr'r'n vX*�L <br /> ITM MI►el1+ArT^tf►Urd IfRaC t�)yceFT ryipr rm tt11T m+'mn1 <br /> i T r+aMe ON EI,r!n1 <br /> Trlrr rca�o 15 nfarrriMron phaN rry�npL7li�'1A?S1Srli4T'� <br /> rrar110dfllydliiLpllpnbUBln444 � Y c _ i <br /> mfi e <br /> 3 I,r-:t fpe6 to tie 5Gw er g,yen Ie the pvbli: <br /> Y1il Fvop tg Qrcpticlr�� : Sec�ta <br /> a 1 a-,s praming foot that,s NOT prepared at home 0l(es❑tFn <br /> AV faces prepared or-Ste or is fr=approved commercial favkt:es'. j'rem❑rra <br /> ?bane: <br /> TQarne,r faalty <br /> Address of farifty. p„ r r'dtiori areas frog'Wes <br /> 5 1 Am pranding a booth vrith th±Foticvnng:ito Prclect my;,r:parS,ag,._ion and foods apa <br /> du.and the public) - <br /> CJ A booth with waits and pYing constructed of either wood.canvas,p!a3be,senilar material and fine mesh tly <br /> screening,completely enclasing open food areas. It Walt atso have a smooth and cleanable Boor(concrete, <br /> asphalt clean tarps and smooth wood are acceptable)and constructed to separate food and(nod prepar—WI t <br /> areas from the pubJ4 <br /> tJ 6Jier(specify): <br /> Note: The only operations not required to protnde enclosed booths are those which sell beverages frcatt <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 5 Approved water for drinking,utensil and hand washing will be provided in my booth by the following methxlsr <br /> (�Approved bolded water. <br /> Orl-sde hose bib that is connected to a potable water source <br /> ❑Other(specify): <br /> T. Electmily is provided for my booth's use:❑Yes❑No <br /> I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all Imes of booth operation:❑Yes❑No <br /> tam providing[he following hot temperature control for the hot holding of all Wentially hazardous foods above <br /> 135"F: <br /> U Camp stove ©Sterno&hotel trays <br /> []0oubte sleamer ❑Steam table&lids <br /> ❑Electric slave top ❑01her(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked Means, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 186$E.Hazeltorr Avenue95205 <br /> Slacklon,California I T 209 468-34201 F 209 464-p138 + vtwev sjcehtiCOm <br /> I ra n7 <br /> GX0 Pupa 7 0 11 <br /> iEMP EVEWT APP <br />