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Environmental Health Department <br />_________O&lojs) <br />2 <br />3 <br />4. <br />5 <br />C <br />moats, tanulos. cookod beans, rice. <br />sell beverayes frrxn <br />m frrwn appwotf comwercw* facitiw ^Ve5 so <br />—. - __Phone ( } .$<• ferrifan <br />my unpaCGSpod food a«xj food (zeparation anws from nxis. <br />SAN JOAQUIN <br />- COUNTV <br />TEMPORARY FOOD VENDOR S APPLICATION <br />1 <br />Tv I'J/puC— <br />d- <br />AllernaK ( j <br />axe <br />J.™* "a-'ellon A‘,enu* i SwcMon Cakfomia 9&205 I T 209 466-3420 ] F 209 4M-013S | <br />O’t,arfl f H •/■ww.Sj-ceho «m ii <br />I.w • -.th’ fcH* <br />7 tJechcily is piuvided Jcr my booth s jiic.JFTvqs Q No ---------------- <br />3 I am an accurate prohe FvjrnwxTicter to measure the hot and cold homing «M petenjtajv hazardous <br />'uixts dutmg alt Um,,, ot IxxMh otwdbcr. Q VesQNu hazardous <br />9 I am p^-idor^ the foUowng hot tompcratum control for me hot holing of aS potent.alty hazardous foods aho-.-e <br /> Camp stove Q sterno & hotel trays <br /> Doubta BUMtner -£Lsteam tabto & hd« <br /> Electnc sfovo top ot-x.1 (ipacfty <br />Not®: Examples of potentially hazardous food Include <br />voflciablos. potato salad, oggx and dairy products. <br />a s^nad and compteted copy of ttss cheetts: to <br />■hiame of GaiSSksiAS O <br />The fGi<Kv.n:) is irformaton about my (xguruzaSorvb-iSJf^y; <br />Name of organuafnrvbusines£\ TV i <br />Address ZI2-5 (Tkl|(c<n,y, <br />Phor^ (1M) 4€>2-?2L^( <br />l st food to be sold or given to tlw publlcTft ( <br />f am pravktog lc«j (hat is NOT prepared al homo: yB5 Q n* <br />Mfood is propurwl on-attu or i. :.,... __________ <br />Name of faculty /i'L I ( <br />Aodre&s of facility /'VC VlK.i »n A <br />i am providing a booth with trw, fcecwmg (to p/pirf <br />dust and the pubiie) u <br />fAA booth wdh walls and ceing constructed of either woed, canvas, plustc szruter matentf nnn fine rwh <br />r*0**'0 '°m an>a9,! wi a,w ;^i (eXT <br />pXB'W 5TOO‘" *lXnl i,cwp,abk3) anG “HSUucsed to soparote food ano foud promotion <br /> Other (specify) <br />Note: The only operatons not required lu provide ercosec booms ore those which <br />npnrcvijd (MponMfk «>r propftcfcagtjii foods from approved sourixi* <br />Apom-reil water for drtnfong, ufonsJ and hand waafwig vntt bo provided in my booth by inn following nwirods <br />(^Approved txitltod wator. <br />[j On-sile hose bb tlwf is ccnnncted Io a poiatde water source <br /> Omer (speciiyj