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r* <br />SAN JOAQUIN <br />1 <br />2 <br />Phom <br />3. <br />4 <br />9 <br />moats, tamaloB, cooked beans, rico. <br />UMPf /(..HI APp <br />7 <br />8 <br />5 <br />,IM t H-vellonAvonunl Cuhlomia | T 20B 46B-3420.| F 209 404-0138 | ww.sjgov.OfB/eM <br />“ v r ■ a/ i r . z. • . » . . <br />mo if;/)? 1 —- <br />0//<JV/G24 <br />f/ th)'! io <br />/c? IHealth Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both lot profit arid non profit) arc mquirrid Io fetorn a signed and axofAitod x f'/ <br />tiin frjfilival c/jorrlinator Ihrc'' f'ij //ockr, prior fn this event <br />1 Name of Event .(jJ ----------- <br />fhe following r, information about my rirgafn/ntiori/horjiriosf, <br />Marne of orqariizatiori/bir.innsr. TV\ g <br />Addrm.fi <br />I mt food fo be sold or given to the public. <br />I am providing food lhal is NOT prepared al Ftomm O Aos f^fo <br />All food io prepared on-rjfo or is from approved commercial facilities: Mf 10 _ <br />f'l.'irna Qi for.llil’/ l<X/^Phonp L-l.—----------"___. <br />^pdlhepublct 1 <br />□ A btmih w3> W'-tlta r.imM.fia <>l nilher M>ai. a>rwM. P1®^ XnX» floor (Concrete, <br />rooc arld pro^l <br />areas from the public <br />Ollier (specify) lZ?..zc_14>.—lidK-'t----------------- ’ <br />T8O only oprfont. not Io provtdo ondosed booths are those which sell beverages from <br />" appn//ed diopffr.serB, or prepackaged foods from approved Bourcoo. <br />Approved water tor drl^ng. utensJ and hand washing will be provided In my boolh by the following methods. <br /> Approved bottled v/ator <br /> On-dilo hose bib that is connected Io a potable water source <br />otiif.-r (specify): <br />to measure the hut and cold holding of potentially hazardous <br />Iff pov.dmu ft'L1 pZwm!; MM ’ho hot holding of all potenllally hazardous foods above <br />n enmp stove □Sternoft hotel troys <br /> Dopbtestnnmer Steam fnhln A lids <br /> Ktodnc stove top Otl»r (specify) <br />Note- Exernploe of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.