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image2.jpeg <br />l <br />5AN JUAUUIN tnvironmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />8/5/23' Na~>c o( Ev^l <br />A):*rn.VP (Phone <br />Lis' *co3 to tx* sod v gw«n id the puCi«: __ <br />4 <br /> Other i sp«A <br />9 & <br />9 <br />rwmeats, tamales, cooked beans. <br />,fi^F H.ve'fon Avenue Stockton <br />I <br />I <br />Nam* if erpinjafronfous'rw’is <br />d i <br />of booth operation Wes No <br />I am i <br />t35"F <br />£j Camp stove <br />0 Double sfeamor <br />^EJecric stove lop <br />Note' Examples of potentially <br />vegetables, potato salad, eggs. <br />cafcm. 95205 I 209 468.5420, F 209 464.0,38 • <br />*'*?• ’o'r <br /> Other fspec/^) ------------------------—==<--—--------------------------- <br />; ot" <br />;™e,'n3”Mto^ng hot fc^ute »«»> to the hot hokhn,ot all WWMtt, bauttot, too* <br /> Sterno & hotel bays <br /> Steam table & has <br />H Other (specify) <br />hazardous food include <br />, and dairy products <br />^kjged foc<f and food ©mpanrtH^ *reas hen <br />(4^/a (—— <br />l 5-r D-cvtiir.; icod that« NQT oropared at home res .S^o <br />Au toed e prepared orv-s4e or is from approved eommoroai fariMies ikT’^.. - N') <br />,, ,. PTicne l 1_____Name of fadit)_______________— u <br />Address of fac*ty--------------------------------- --- ------------- <br />I am prev dm-j a txxJtn wth the tokowng i to protect my uni <br />«Jwst and the pu&lcl <br />Sfcjfsooth wtV wais ard ceimg constructed of either wood canvas r'astc vmilar <br />5S1ng open food areas « writ also have a smooth ary1 deatcooamt <br />Xn toms and are accept and constructed to separate food arxt ood preparation <br />a-eas from the suDIc <br />Note The only operations not reared to provide enclosed oocrhs are these vm.ich sen Averages horn <br />approved d.spensers, or p. epackage J foods from approved sources <br />Approved water for drinking utensJ and hand washing will oe provided m my booth by the foitowng methods <br />^App-oved bc'!t,«d water <br />3 On-s.'te hose hiD tha’ -5 connected to a potable water source <br />>j vendors it»«h h' woff and ncn-orofiti are required to retur” e signed ard comp*''*- ’ mpy <br />tt val tome iJl 'weeks prio- to to® event <br />Manteca Park-A-Palooza <br />'>» f'.-lbwing s ir'ornw>cn about my organuatmbusr-ess <br />i - v <br />< dw i vl