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S A N 1 Q A Q U I N Environmental Health Department <br /> PORARY FOOD VENDOR'S APPLICATION <br /> Au row venuors tom+ror prom am non-prom)are rew-au to return a signed and completed copy of this cheddlst to <br /> fttO feafiref eoorrttffW three(3)weeks prior to this event <br /> 2. The tollming is tntiorrrmbon about my <br /> Name ar orgardzafior res& Ila <br /> - <br /> Phan: (' )_ �-0/11 _ Awe:(Zxj ) <br /> 3. gist food to be said or given to the pubes; nz�k�_, .c� s c'�� <br /> 4. t am provic"food ttud is W1 Prepared at home:,0 Yes❑No <br /> All food is prepared on-slur or is firm approved ao/m/rnerusal Q'yez Q No <br /> Marne of f r �G u Phone-(-",1 4 <br /> Address of faoifityr -q Z It L ,-,- �a ^ 1P I rJP <br /> 5. t am providing a booth with the fokmvV (to Voted my tatpadaaged road arid Hood-pmparation areas from hues. <br /> dust and the pub&',) <br /> ❑A booth v tt waft and cimbV CorEructed of elder wood, my4as, Plastic, eiitm,or material and fine mesh Ry <br /> saee g erg open food BMW- tt WA adSo have a srnoaet and demmabb Boor(=Wete, <br /> areasaspha ltod tutu and am uth woad aD accepttrbie)arid d to separate tuod and fund preparation <br /> frmP� <br /> ❑Other(spay)= <br /> Mote: The any opiraons not M9Ji ed to provide enclosed booths are those wtucu peg beverages from <br /> approved disposers,or prepadmqed ftw&harp approved sources <br /> 6- APProved water for drir4mV.utensil and hand wasttfrtg wilt be provided m my booth by the foltaw9rtq meamdg <br /> Approved bof ed water. <br /> ❑On-site hose bib that is connected to a potable watt(source_ <br /> ❑tuber(may): <br /> 7. Tic ity is provided for my booth's use:❑Yes❑tWa <br /> 8. t am providtg an aomraha probe#wnwrnetas to n amye the hot and cold hok&V of pouw4iaffy haZUdaIS <br /> foods during A times of boots operafi r❑Yes❑No <br /> 9. t am PrOYMIa►g the fallowing hot guTtparsh"control for the hot hoitdiny of ar pafartttiapy haaandouts lioxids atom <br /> 1 35T: <br /> ❑camp stove Ste >p&ttdt trays <br /> ❑Dobie steamer ❑Stem table&firs <br /> ❑Eledrtc Wiwe top p other(specify) <br /> )doge: tramples of POUnNONY h=Wdorrs food kmkxhr msaft. tar **. cooked bmun, rice, <br /> .POWD salad,eggs,aw daby p,.,�,� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464 013g un,�,r s)gnv.orglehd <br /> 6MB/t vt�ge r d t t <br /> iFW EV@W APP <br />