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I <br />Environmental Health Department <br />5< <br />2.?T« <br />lo. <br />tvoi <br />CH' <br />Ou 3. <br />4. <br />IUS <br />5. <br />1 : <br />it <br />.go 16 \ 1 0 <br />)b <br />6. <br />9. <br />ifi <br />ie <br />y »> <br />i <br />7. <br />8. <br />i <br />i <br />I <br />I <br />Li <br />is: <br />irk <br />I" <br />}E <br />ji» <br />lei <br />CA _______ <br /> Alternate: ( ) <br />rje 11 uA, Sy m p^j Vl€c/mq GgJ o a <br />Yes No . <br />commercial facilities. <br />Ip OKA <br />T~hA rd ^4-, <br />IBSBEHazeHonAvenue! Stock,o„. CaSto„ia 9520s , T <br />Ofl/twn PaoeJofii 1 r ^ua 464-0138 1 www-slgov.org/ehd <br />TEMP EVENT APR <br />SAN JOAQUIN <br />COUNTY <br />I,,, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />SeSlalcooTdC ,o retum a s|9ned and comP|e,ed <br />1- 1. Name of Event: looU H.Y L+Z Date(s): ~ ' <br />The following is Information about my organization/business: L- <br />Name of organization/business: S, ‘"TXa.Q I f J /) (J A <br />Address: 1 hS>(.TyO <br />Phone: () 931 <br />List food to be sold or given to the public: ^CVmSj <br />I am providing food that is NOT prepared at home:^<_> .,v <br />All food Is prepared on-site or is from approved commercial facilities:^ Yes No <br />Name of facility: ____________>hone: 98 ( <br />Address o faclllty:__lK£D TkUrd fitYi ybo n ------------------ --------- <br />dust and the puW^ W'th followin9: (to Pro,ect my unpackaged food and food-preparation areas from flies. <br />screening, compSlyEnclosing9o^n'foodlreas^if wSs^have asmS)^”^"J31®''3’and fine mesh fty <br />W0°d - aCC6^ 3nd -structed toXSe f^^nX^ <br /> <br />pother (specify): I 6 \ I D j <br />N°,e: th°- <br />Approved ^,lnUna, u,ensi, and hand wash|ng wj|| bB <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify).________ <br /> Electricity Is provided for my booth's use: O Yes'S No '—'—~----------------------------------------------------- <br />foods during all times of booth^peratto^^ and co,d holdin9 of potentially hazardous <br />J pmvdmg the foiling hot temperature control for the hot hoidlng of al! potentiaiiy hazardous foods above <br /> Sterno & hotel trays <br /> Steam table & lids <br />NOther(specify) <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />Note: Examples of potentially hazardous f <br />vegetables, potato salad, eggs, and dairy producte?