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Environmental Health Department <br />of thi? chedcSst to <br />Dato(s)' <br />1. <br />2. <br />Address: <br />)Phone: <br />SSic <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />‘ i 0 No <br />.wrcial facM’o* <br />SAN JOAQUIN <br />- COUNTY <br />from <br />M __ _________ <br />1668 E. Hazelton Avenue I Stocks California 95205 |T 209 468-34201 F 209 464-0138 | www.sjgovWehd^ <br />tHDi^ Pagerorn <br />OtviWlO <br />Alternate. ( J — <br />[Xyes D No <br />on-slto or is from approve com'"wv‘° <br />and lood-^^3^ are <br />■^foliowln^ potect my unpackaged too <br />... , wood. canvas, plastic, ^Xble (concrete. <br />which sell beverages <br />Ust food to be sold or given to the puWic: <br />I am providing food that Is H2I Pfopared at home: Yes <br />AB food is prepared on-sito or is from approved comm„. <br />NwwoftaW <br />I am providing a booth wl- . <br />dust and toe public) <br /> A booth wXh walls and “n«^ ’ <br />flothorCspddfyiniLBl-^---^---- <br />Noto; The only operations not>e^|^dfromW'®'ed sources <br />approved ttaponsen.. of pt P 0 following methods: <br />, uten5il and hand washing will be provided in my booth 0y <br />Approved water for dnrwlng. urt <br />^ApprovwJ bottled water. <br /> Onsite hose bib that is connected Io a potable water source. <br />hot and cold holding of potenbally hazardous <br />stove 0 Stemo & hotel trays <br /> Double steamer Steam table & Ms <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AM food vondors (both for profit and rton profll) are raquirad to return a signad and f <br />too festival coordinator three (3) weeks prior to this event. <br />1.Name of Event ..I \\ C. —1^13- <br />Iho following Is information about nw organizabon/busincss <br />Name of organizalion/busineas: —Q— <br />(r^ <br />q -S