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6- <br />meats, tamales, cooked beans, rice, <br />a <br />7. <br />3, <br />136T:. <br />[ | Camp stave <br />□ Double steamer <br />□ Electric stove top <br />F 209 4^0138 | <br />... ? <br />: . , x ;.v,-,.. <br />r r.t •> Jf <br />III. <br />. ....... gH <br />TEMPORARYfoob <br />1 i Name of Event; LodLS^^4 ^11 <br />5 . Name of oryam <br /> ■'' ■ fe,teSS: yfetlrt/fe^^ - Phone: (AJ *) OOO^P-3. p fe^KI ^OI <br />3. List food to be sold cr given to the public: foLklA€(^^SL-^AXn J5'■ <br />4. I am providing food that is NOT prepamd at home: LlYes^l No foUo.^ Kool <br />All food is preparedop-site or-is •from approved -commercial facilities: □Yesjfe] No . .>-. ■■..■. <br />Name of fao’lity: ----------------- --------------- -----------------------------Phone: k_-L--------------- <br /> 5.. SwSHis■'oust ano ine puoiip/ <br />^agSaSBSEBSESEB <br />Note- The only opemhons notfrequimd to provide enoteed 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 vvfllbe provided In my booth by the following method? <br />Approved bottled water. <br />□ On-site hose bib that is connected to a potable water source. <br /> <br /> FS^32S5S£E5SiE3-d coM hoidinq or ESSSEZ <br />: ■ 9. ®ySu'a|lnB|||Sl®r||i|g WzaffiSfoodseb^ <br />□ Stemo & hotel trays <br />□ Steam table & lids <br />□ Other (specify) <br />Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1868 E. Hazelton Avenue | Stockton. California 95205 (T, 209 468-3420 | <br />EH016-07 <br />07/3/17 <br />" i ■ T • ' to '. .to- "i.;. <br />> to ife^E <br />s. • ■to h . <br />-X'J- <br />Ctoto ■ <br />f y \j — — ■ ~________________—---------------------------------------------------------- <br />sold cr given to the public: <br /> ,toto <br />WWW