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Environmental Health Department <br />i.I <br />z <br />Address <br />510 <br />^>7)/ <br />3. <br />4. <br />5 <br />6 <br />9 <br />meals, tamales, cooked beans, rice. <br />Hole: <br />A <br />£ <br />7. <br />0. <br />1668 E Hazelton Avenue | <br />KMD1S42 <br /> No <br />TKf feciifies: Yes O Wo <br />Phoiw:!____1 <br />SAN JOAQUIN <br />C O U N T v <br />stb tfxjse wtiich seSl be^arases ft cm <br />iI <br />Ptw?. ) <br />Lex food to be scW cc g-ven k pttfia <br />I am prrwrfr^ food is WQI P^®^»« ® Ves <br />M fcod rs prepped cr>^£ cr is frwn corrmen <br />f iarre of fiacfit/--------------------- <br />(» fcod and ^r. <br />dusi and 5» pJfcfc) <br />« =^= ’^3fc" <br />sreas from the p^'c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />' ) are reared to ceium a sv«d ard cxrrpZded cc^/ c/ tm tfjecZW to <br />tieteSlvrf<xo^'naitorrT^(3)^*sprixtotb^<-*rt <br />Cc^!c' 7,2°^ <br />The toScurng a inforrneujn atouC my crgaTtzatxjn/Euuness <br />Name cf crganvzaCon.’fcusiness: <br />Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | <br />PagaTc/n <br />tJ <br /> Ocber fspecfyX-------------- ------------------------------------- --------------- <br />Note The only ogeraSons «* hk^k* to pcwtfe encfcserf tact?® <br />Z^/erfvaterfcrdnrAing utenaiartf ^*«rtngwiatef>ro^ <br />Agprcwed fcoCSed w^e?. <br /> O^sae hose bb && « connectorf to a potable water source. <br />probe Puewn^Ser to measure toe hot ane ccfc! toidng d pctertail'/ hazaHJas <br />J t^^Sr^cntroJ tor toe hot hoidng d al potenea^r haza^fcus foods above <br />Q^Store □Sterro&tece trays <br /> Dcutoes!e2rr.er Steam table & lids <br /> Efectocstoretog OOIter(sp«HW <br />Examples ci poCmtaWy hazardous food mcfode: <br />/jfrA/d- fa'™ ------- <br />Lfp T^/i UT^f ^^2^ <br />-^ry 93 $7? /yeemetef >---------------- <br />__________ <br />AJ toed venders fbeffi far prcAt and ncr>p’cft> <br />Cornic-