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&vtorsiiwflits8 iHtaW <br />3. <br />4. <br />5. <br />6. <br />meats, tsmaloe, cooked fooans, He®. <br />1. <br />2. <br />7. <br />8. <br />9. <br />SAN JOAOUiiM <br />......COUNTY-'- -■ <br />18S3 E, Haaelton Avenue J Stockton, California 95205 | T 209 <168-34201 <br />EHD 10-02 S <br />07/3/17 <br />tha festival coordinator three_(3) weeks prior to.this event. <br />1. Name of Event: <br />The following is Infonnation about my organizationtalness: <br />Name of oigenization/business: ,X_^. <br />Address: <br />PI lone: <br />List food to be sold or given to the public: <br />I am providing food that Is ^OT prepared at home:^ Yea Mo <br />F 209 404-0138 | ^.sjcehd.com^ <br />TBflPOSWY FOOD VENDOR’S APPLBGATSOM <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of thia checkliet to <br />event. ; , <br /> <br />organizatlon/buslness: <br /> <br />/V> 44' < //frr4_tA— <br />2^Alternate: ( )------ -----------.——-—- <br /> _______ <br />[ Mlf | | in ■■imu ■<J i'.uli mm m f ■-■ y™. — , <br />Ail food Is prepared on-site or is from approved commercial facilities: R) Yes No <br /> Name of facility: Phone;*------1------------ ---------------------* <br /> <br /> fam providing'a booth with me following: (to protect my unpackaged food and food-preparation areas from files, <br />dust and the public) yy / I \ <br />SSSSfiSMSS - •»*•»» ■“ ™““ “ »»"“ <br />areas from the public. r f) 1 ./ C', <br /> (Xote «: <br />Note: The only operations not raquirod to provldo enclosed 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 will be provided In my booth by the following methods: <br />^[Approved bottled water. <br /> On-alto boss bib that Is connected to a potable water source, , <br /> ------------------------------ <br />SZXidinTanSS »«« anU c* «lnS of poto-y <br />, XX“ mVX^KXlXPeonrAfVMln 0 of a« potonMy h^ous foods above <br />135’F’ <br /> camp stove Sterno & hotel trays <br />Q Double steamer Steam tabfe & lids <br />O Electric stove top U Other (specify) <br />Mute- Examples of potentially hazardous food InGtads: <br />vegutebles, potato sated, eggs, and dairy products.