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3/25/22,9:40 AM IMG_0071 -ig <br /> row <br /> g <br /> J A NW Q U I N Environmental Health Department <br /> TEmpORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> +,th>e tlr�tn�atl mmrnadl}maiffirr Itht,tee K�}}m }�(4Dmfmr boa f�Jtits ram- t <br /> 1. Z�ZZ <br /> 1.Name of Event: <br /> MGM �YvS`,V(3ad(5PN1�'/�74 ,S7Li �Y <br /> 2. The Iblimm1mgg is imtb¢rmm*0m ab=g amo-Y®ggami.amimm: iirt <br /> ttfttmre colt m�r�tgamiialtr i'tfiut�airtss'. �A NJ� l7 tZ 5 �/V11 N' _ TS�11n�— — — <br /> Address: <br /> 31 uisit fbud to Its sold or 9we+m to tone g}nvfGtwc: — <br /> r <br /> r <br /> 4 t WM RNOM'dimo food d oat1�s MOT prttyared at tia me 7,Xe No � <br /> All fent[I is p>>Mwodf ��m� �yesQl�, <br /> � yes <br /> / <br /> tom.ox>��., y ,q �2 F <br /> Adfams of;'.iWAo areas from Hies, <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation <br /> dnsg awdl Rhe Plib1ici) <br /> A booth with walls and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly <br /> /area +mime ¢mmm�lk �rrrilosiirte sum bad areeas. M �hgim a smmam h and dkeami dle Ibm t2tar�tr°, <br /> asoftaljl dlemm=ffps and smmdb w=Dd m a bIB)Bnd 20 sePamtlee tl nd arrdlbndP,?Ppwgror i <br /> areas from the public. i <br /> i <br /> maw: Thhe mmi�y gperalt,� rtrmit nhwi"Odi ID gpTM4't��effdased t�� dh vWh dh -All Ta torn <br /> appoxetll a}5pemsE s.or � s ftm,aPP m <br /> 6 App�a�ma r[ion'&u tbng mttemt aarrd hand <br /> eorlll'�pu�ii �my Etimrctlln�'�fmilt�aiimgg rm�ittreonits: <br /> Approved bottled water. <br /> i; <br /> bh�a a�awwwxNad%n a poUtia meat SOWaav;. <br /> n(iMharA Cdk NoZ' its tlmrr trrm�bOUN n S 10fir Yes <br /> F: <br /> 8. I am providing an accurate probe thermometer to easure the hot and cold holding of potentially hazardous <br /> ft dunirr� 'Mn Yfed�] i <br /> �e termer a� ��r t�tn II»>��of Bill �lyv thretzaa,mlmus tfrnrt&a�maee <br /> t am Wing tfq a tkatlienao ipg Ih a I <br /> 1Cm Sam,= Its IR � <br /> ®sue steamer S�aPrr Mile A' <br /> WS �J/A Fo- L) <br /> IEIV4r e D ommir I <br /> Note: Examples of potent g4 hazardous Pr u Include; meats, tamales, cooked beans, rice, <br /> eggs,and dafttr- <br /> Vagebokm.Pubw <br /> ia 9520�T ZOJ 468-3420 F 209 484-0138 www.sJcehdEom <br /> 1868 E. Hazelton Avenue Stockton,Califom T <br /> Afflp <br /> etc <br /> mrranr <br /> s. <br /> https:Hmail.google.cOm/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGmvfrwXzVRLWPPCPXvrhRWrVkB?oroiectnr--1 , , <br />