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Environmental Health Department <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />food include:meats, lamafes, cooked beans, rice. <br />7. <br />8. <br />All food is preparedpn-site or is from <br />Name of facility; <br />Address of facility: <br />I am providing a 1 <br />dust and the public) <br />dMlV juaQuIh <br />EfiD 16-02 “azei,cn ; Stccxion, Californio: 95205 | ^209 463-3^20 ; ='209 46A-C-.es ; .. <br />Page 7 Olli TEMP EVENT APP <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />ssxfiiSXKszr10 re,um a m <*«**« ■» <br />' ’Nan”o' Ev“': VW,____■ <br />The following is information about my organization/business: ‘ <br />Name of organization/business: 7k, C- <br /> <br /> Address: PltkWQ 6g <br />Alternate: ( ) <br />List food to be sold or given to the public:^ <br />lam providing food that is NOT prepared at home: Q^Yes No <br />----------------1 approved commercial facilities: C^Yes | | No <br /> <br />. .1.17^ Wiping: (Jo'p/oted^iy Jnpacteged food^nd f^Xre^ration areas from flies, <br />“r plas,":-simter “ ™ «y asphaft, clean ta%?ana^S S « aSbte) a'^™^, at"”"" “ d""abte ,l°°r !“r“te <br />areas from the public. acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />Ote’ ,hose *Wch se" beverages from <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />O'Approved bottled water. <br />k^On-site hose bib that is connected to a potable water source. <br />Q Other (specify):_____________ <br />Electricity is provided for my booth’s use- Q^es No ---------- ----------------------------——----------------— <br />,he h0’ “ ho1*19 °f <br />' toT'""9 ,O"“"’9 h°' «>nw <» the hot taWns ot an poMatly hazardous foods abo»a <br />□ Camp stove B^emo & hotel trays <br /> Double steamer [J Steam (ab|e & (ids <br /> Electric stove top Q Other ^6^) <br />Note: Examples of potentially hazardous <br />vegetables, potato salad, eggs, and dairy products.