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SAN JOAOUIN Environmental Health Department <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> I fL.;lraht ane re n-woril'i are Yj return a!iKined arVJ rrolnp"ed ropy CO the4 rherr_rMt In <br /> t`!r,•,•�,tta:�l i.:'�[litiirtu•tnrcrr{.'.1 wat+Ls Glnla to Ibis rzrtl. <br /> 1 N,1lnc(rl E-on"I -j e< tr'3� ray flatrysl �-+ u._ <br /> -t. tollowtng.s Irioeratort oc e,my nrgan1laOCnfly r51rrg55. <br /> Name cArrr9aijz;e n,btt:nras -611,11z <br /> lulRrass 1_- 1= Ir±.!-r IiI CD <br /> Php 'L_ I C-3. _{ ��� ?( Anemate I <br /> lr9t lu_god Ga`hrt SdC rlr qr.�n Gu Ihr cubic: r _ 1r- � 2. - __ c `� <br /> �. 1_�'t�r �`_3 '► �•1(_(_ lh f�,1�[- Y=fu? ._•1c��[ r 1 X11 Lint :� _ <br /> t ar MET prt Froums"g food mat is epared at ytdne Yes❑No .lL <br /> Al fcm-A t is pretmired on-vie or=s korn apprclygd rxierip ial rarAft yes No <br /> %arre of tautty �71r�r- CIF_I-n rr l,` :7G� 1Pnrx►n r f ,4 4� :7 <br /> A,•10'@*;5 Of 0SEAlly._ ` 1--} ^-. f'?'��-r t 5 f _ It',� 1`•t,a 11 I..+I - LH`Y-,J3 <br /> 5 1 am prnMng a booth with the taMwmq Ito prrAnal rtry u par9 agm rr*d and areas from fees <br /> thy:and the publ'o <br /> ❑A boNh won Wat15 ano oeiYrQ cAnm%r_9ec cf ember-ArxA.canvas pla6br.Samar m0iWrial and fine mesa fly <br /> scrr.:ntng rtmpletety eneloernq open food areas It wil alto haxw a w rlth and Cleanable IFxv i:ccnvete <br /> asphalt.dean larpr,card atttoolh wwod ae ao=tabley nrd constntded to 5epi rtme Sood and food precaratr=n <br /> r}eas rrcm the puMle <br /> m oine,{tpwyf: I ) Y.- — <br /> Mdift; The only oWsoorte wA rtyqurred to provide enclosed :uxdfis are thoUe WN ch Set beovera,ges from <br /> aa`lo-w*d depenaere,4r prepackaged floods kom approgRd fewi s <br /> G,, .waived water for drinking.ut nsA and hand washinq'wrll ba prwftd in My booth by the fa/amrg"thoe5. <br /> ®Approver)bottled Kavr. <br /> a0n-cra Mse loth that is connetLod to a patabia water SixrCe <br /> T Electrraty is pmy ded rot my broth*s use ElYes❑No <br /> fl 1 am proNd4rrg an s ysie probe Vtertriorneter to measine the hot and rd(%holdrV &wowrtaly hazartXxn <br /> foods du ng all times of booth operation ®Yes❑No <br /> 8 1 wn 0mvtding that kftoerq hrit 1wriperature aontrd kv the lust h"riU of all poterhalfy hazdri;%jcs foods ab.Ne <br /> 1 W5•F <br /> E:ramp stru re J@ SternO d h'A&I IYa <br /> [1t.GojtA---simmer ®Steam table 8 Ids <br /> J E:WA K Stove top ()thnr{sptu Jyl <br /> Nate: Examples of potentially hwardous food include: meats, lamales, cooked Wins. r1co, <br /> vegetables,potato salad,eggs,and dart'products. <br /> 1W E Hamlbrt Avenue 15lrxklurl.CdIdwia 952051 T 2N 468.3420 1 F 2u9 st"-tit 10 I axN s,u erg chd <br /> t-1f9 It 11it 1•Na 7 d!e ttrW L%T M•46-V <br /> b Je'Y.is <br />