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Environmental Health Department <br />2. <br />//) by) trT~/O. <<A <br />3. <br />4. <br />& <br />8. <br />mwts, tamilM, oooktd bMn«> rtot. <br />https.7/mail.google.com/mail/u/3/#inbox/KtbxLvHHktzsVsXFwxktPvwbGQNGGzxzcg?projector=1&messagePartld=0.3 1/1 <br />9/24/25, 4:30 PM <br />.... <br />IMG_8593.jpeg <br />....- ........... <br />7« <br />8. <br />9. <br />■ .«• <br />r j <br />. L': r'x^s if <br />SAN. JOAQUIN <br />----COUNTY------ <br />r-. <br />12??a « Hazalto0 Avenua | Stockton, California 952061 T 209468-34201 F 200484-0138 | www.ajgov.orfl/ehd <br />fflSlSS IWofll TEMP EVENT AM* <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />t0 retUm a 8,flned and -py of thia checks to <br />1. I.Name of Event <br />The fbltowfng h Information about my organlzatlon/buelnew: <br />Name of onjanteatton/bualnesa: <br />Address: y 7^/ T7/t>z^ L <br />PhOne: ________ Alternate: g^Z ) N <br />List food to be sold or given to the public: cS/(£, J L^tA C~^ ) <br />I am providtog food that is NOT prepared at home: Yes No <br />AD food Is prepared on-slte or is from approved commercial facilities: Yes No <br />Name of facility: CP^-NIC^A- Phone: (T^V) S'//- ^5^/ <br />Address of facfflty: /^3g C^idSC^q/^ /LQ. <br />* ^stamlflhS public)1 ft>flowinQ: 1X01604 W unpackaged food and food-preparafion areas from flee, <br />Q*1”04*1 *** J^8 ®nd ceUIng constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />aS^omtfiB pubfltT1118rnooth wood “• acceptable) and constructed to separate food and food preparation <br />$3 Other(specily): yZ /^^g^/rr^o /4/ <br />Note The only operations not required to provide enclosed booths are those which sefl beverages from <br />approved dtBponaora, or prepackaged foods from approved sources. <br />Approved water for chinking, utensil and hand washing will be provided In my booth by the following methods: <br />C9 Approved bottled water. <br /> On-slte hose Mb that Is connected to a potable water source. <br /> Other (specify): <br />Hectridty Is provided for my booth's use: u Yes No <br />»am proving an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during Ml times of booth operation: B'YesQ No <br />^J£2vW,nfl totowtng hot temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove Stamo & hotel trays <br /> Double steamer *0 Btaem table & llda <br /> Electric stove top Other (specify) <br />Noto: Examptoe of potontisKy hauidoua food Include: <br />vegatables, potato salad, eggs, and dairy products.