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a <br />F- <br />5. <br />6. <br />pnno'Z of 11 <br />am <br />7. <br />8. <br />9. <br />4. <br />meats, tamales, cooked faearm. rlco. <br />x-7 -Sa <br />- <br />F 208464-0138 | <br />I.Name of Event: Irxil SWlzd ----------- <br />The fcllowlna le Inforrotlon about my oraontalton/bualnese: <br />NameoforsenWonftiielnoMtr <br />Address: <br />Phone: <br />/ ''' : <br />. s -s;M <br />Environmental Health '••Department- <br />. , <br />A-rtr-.-!TEMPORARY FOOD VENDOR’S APPLICATION :■ r <br />_Dale(s):‘ id//?/?- <br />■"ial <br />_ <br />------r------- <br />...aSANJDAQUIN <br />I- ... 1) --COUNTY----- <br />'Sirf'’ Groolnws yn’"-' li«r. <br />. — >J u— M eew <br />1. <br />2. <br />a signed and completed copy oftti.ls c <br />_ ________ __Date(st '•' :|d <br />. . ‘rY-'J <br />(olnkde^s fak.Vf’.viA.^^ <br />______________ Alternate:( )_------------ <br />ust food to be so. orgivah (O .he pul3llc:<±l^ <br />I am providing food that Is NOT prepared al home: □ Vosfe No Kool 9 <br />All food Is prepared on-slle or Is from approved commercial facllllles: Yos^l No <br />Name of facility: ------------------------—---------—-------------------- Oll0‘ <br />dust and tho public) <br />□ A booth with walls and colling con8lr^,Qd of 01111 ^i^have asmooKnd 5oXble'floJ?1cQncmta^ <br />“Sl"?ie^ndnB0SS S X^btVSdlonXJ’d to eepatete food end food prep^on <br />areas from the public ' 4-1 f) <br />M , . The only operations not required to provide enclosed booths are thoWwhich selt beverages from <br />N°te 1apprA SoS, orprepeckeged foods from approved sources. <br />Approved water for drinking, utensil and hand washing win be proved In my booth by the following methods: <br />^Approved bottled water. <br /> on-slto hose bib that Is connected to a potable water source. <br />mX(^ <br />ihoti’o'd,n0 o,ai1 po,en,'a"yhKa'tiou3,oodB <br /> Cempatova OStornoa hotel trays <br /> Double steamer Sloam table & Ms <br /> Electric stove top 0,hor (8P0cl y) <br />1068 E. Hazeton Avenue | Stockton. Caklornte 052051 T ' <br />EHD 10-02 <br />07/3/17