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1. <br />■ H <br />2. <br />Phone: <br />3. <br />4.• l X <br />5. <br />6. <br />>n-site hose bib that is connected to a potable water source. <br />j ar.' <br />it te■ an i) <br />cooked boans, nee <br />c <br />• ■a!*» 4 l»J . <br />• -.z > rx^et*J <br />’EWP tVLX5 *** <br />•<«- ?n.. rT» • <br />l <br />( ) <br />List food to be sold <br />fi*npU» po*»n’a hAj’<»rt><Xi» food nciub* <br />po<»t« d et/j' a^xl d.vry produr <br />Environmental Hea|n, <br />All food vc <br />the festival <br />iusiress <br />-U ^<L' r> <br />Depart <br />-ther i specify) <br /><d«-1 f'T my booth s use Yes O' No " <br />.<••■ [ ' (.• ,■•■■ .meter to measure the hot and cold holding of potentially hazardous <br />‘ ' r-» r (• ut! .< ' Yes No <br />■ ' • • ■ '• I ‘<.r the hot holding of all potentially hazardous foods above <br />DR’S application <br />requmed to return „ s . .. <br />or given to the public: ^ClVtCtywt pU/4c\ <br />' am Providing food that is NOT - <br />AH food is prepared_pn-§ite onis fn <br />Name of facility; J FCflPS <br />Address of facility. <br />S^en°„OghcX2y « XVo’te!8, Plastic' i:"1"” ma,Mal a, d ,i™ "> <br />s™°,h Xd m <br />Q Other (specify): <br />Note: The only operations not required to provide enclosed booths are those which sell h« <br />approved dispensers, or prepackaged foods from approved sources. beverages from <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />01 Approved bottled water. <br />‘ ~--------------------- Alternate <br />---------------VLy^ihiq I - <br />— J f <br />not prepared at home: Yes No <br />Torn approved commercial facilities; [^Yes L ] No <br />.....••' <br />10 protec? <br />SAN JOAQUIN <br />COUNT Y___ <br />^reotntss <br />temporary FOODvend <br />=1 Swinata lhreP™(3?we 2°n-proSI>« <br />O }r ^PrlOr,O,hlseveni <br />1-Name of Event: JxWF <br />^•o«o-n3,sWomafonabo rgani2ata; <br />ante of °rganization/business: <br />Address: <br />m»at»