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'/: / ■ <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />___PaiG(e;)r _I. <br />2. <br />uA t ■ <br />Address: <br />)_Phone: <br />CpCAkZ-3. <br />4. <br />6. <br />thone which s«ll beverages from <br />8. <br />mcatSr temales, cooked beans, rfco, <br />L <br />O Approved bottled water. <br /> On-sHe hose bib that fc connected to a potable water source, <br />_ Aftemate: ( <br />4>V , hr*Att> <br />7. <br />D& 8- <br />9. <br />SANJOAOUIN <br />C QU N V'Y <br />■1' <br />//. / fv;jr/y <br />4 a <br />»■■ ■ <br />i <br />I <br />!' <br />I <br />■’’••. 4- •• • •- . r <br /> Other (specify): ----------------- -----------—-----— -----------------—»—— <br />Noto: The only ope^ians not rsquirtJd to provide enclosed booths are <br />approved dispensera, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will ba provided In my booth by the following methods: <br /> Other (specify): r <br />.he ho. ro.d or potenw <br />, XX m ho. taU1n3 or an por^y hazanioua above <br />■|35"F: <br />o Camp Stove Slorno & hotel trays <br /> Pouble steamer Steam table & lids <br /> Electric stove top O Ota (specify) <br />Note! EkampteB of potentially hazardous food Indudo; <br />vegatabtes. potato »ntad, eggs, and dairy products. <br />1868 a Hazelton Avenue | Stockton, CaWomla SS205J 1*209 468-34201 F 2094644H38 | <br />EHD IfrOZ <br />O&tWl® <br />’V <br />■':< ■ ■ <br />g <br />- <br />'6z <br />Z- z z z <br />i <br />w <br />Ail tai wncta (bolii lw prolil and non-ptofil) are required In return a signed nnd comptotod rwpy of this ch<,cAdi&-| lo <br />(ho festfvai coordinator three (3) wosks prior to this event, <br />I.Namtj of Event:.....- YY\£L6^X^„ <br />The following is IntomwOon about my organlzaUarVbualnass: <br />Mama of o/ganizaiion/business:___Lzti <br />\0 "As? VCS o r y.<v QC-......... <br />(0.5)A ) <br />Lis( food to be sold or given to the public: <br />1 am providing food that is MpT prepared at home: {2T Yes No <br />.All food is prepared on-site or is from approved commerdal fediities: EfYes O No <br />Nanwof taHty. C.^r-A^ ------------ <br />Adrfrcss of fedfity: . ^--A ^.53^9-^-----------r------——— <br />I am providing a bo^tfi with the foltowing: (to protect my unpackecjed food and food-preparaton ureas fnrxn fnes, <br />dusl and tec public) <br />H A booth with walls and ceiling constructed of either wood, canvas, ptestio. similar material and fine mesh fly <br />scrawroin completely enclosing open food areas. It will also have a smooth and cle^aWe fiGor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) sad constructed to separate food end rood preparabon <br />areas from die public.