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i <br /> SAN JDAQUIU rtviE ; nentaj Health Deparil-J1)5jy- . <br /> C GtJ b)T Y--- <br /> TEMPORARY FOOD VENDOR'S i PPLICATION <br /> All food veridvrs)(both for profrl ana non profit)are required to Teturn a-;lgned and�Ornpleled ropy of lois,chee}slisi:io <br /> the festi=val:coordinatorlbree J3}vaeeke prjor to'this e�,ent <br /> z. -t.Name of Event: <br /> 2. Thefollowing-Ls Wormabonabootrnycrganizaton)business (- <br /> Name of arganjla{ionfiUsirress: � r <br /> Bi na: i61,0q) L -n _ Aitemate: <br /> 3, Lsl lend to be sold 4yoven to the public <br /> 1 am p.rovidWg food thal is NQT prepared alborne es L3 Na C � �q �S <br /> � `f p <br /> ATI load is pr�ared ou t oris frc+m apprAvcil cnmrneroie]Facilities:;1(j Yes ElNo <br /> Name uffaciJify_ "phone: <br /> Address of iaciliy. il <br /> I am providing a booth yviifi fbe fo Iswing',(to pt3leol rriy unpackaged fprY and food�raparation areas'from 41Jes, <br /> dust and lbe publicj <br /> KA boolh xit4 w. a]Is.and ceiling constructed of either wood, canvas.plastic,stn ifar Matarial and fine mesh By <br /> s ening s;omplelely,enclosing open food areas_ It mip also hage',a smooth and.cleanable floor{concrete, <br /> asphalt,clean tarps and smooth wood are.accoiable)and tonslrucic-d-to separate foot)artd food prepatat on <br /> areas from the poWir. <br /> n Other spec y):.__, -- <br /> Note; The only ,operations not reguired to prrcMde 2nelosed booL-j-c are thasA •vrJrielt Sall beverages frflm <br /> apprnved dispensers,or prepackaged foods Isom apprflvect sources. <br /> 1 <br /> f, Approved walerfordrinking,utensil 2nd hard washsng vzitl be pmoded;in my booth by the lolloy,,.ing methods; <br /> ${Approved bAtlted water- <br /> 0 On-site hose Jib#hal is ronnecled to a Aolebie water source. <br /> j3�)ther(specify: <br /> 7. EJectricily is prolfitled•for my boOh"s ipse: Yes <br /> 8. 1 am prmhdiny an a=rate probe thermometer to measure the fol aid u73d holdiog of pnientolly hazardous <br /> foods durv)g 91 limes of haoth fl No <br /> n J am providing Uke foilrnrring Trot temperature control for the Jiol bolding of 214 poronlially hazardous foods abovje <br /> 1;35'F <br /> 0 Camp stove L]Sterno&hotelirays <br /> �Doubleslearrx-r )_]Steam tablet Jtds <br /> Elr^tf<cstovecop ether(specdfo &` <br /> Notes 'Examples of pvtentially hazardous flood 'incltt mats, tamales, eOpked leans, rice, <br /> �+eg etabJ es,,potato sa la tl,•eggs,a nd;cl�iry prod acts. <br /> I <br /> 1W E-Hazeltan AYa o J 4-Gfoddon,Catifmrraa 95M T 213g 4b8-3420 <br /> FE1?- � � 20°48S 3t738 i yrv�vrsjeehd_t� <br /> PD P�v a 77 <br /> Wroj7 aElr.? ',rrlJTlop <br />