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SJ County Fair Temp food application 3019_00u073.jpg6/5/2019 <br />Environmental Health Department <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />X <br />s: 0Yes No <br />9. <br />cooked beans, rice.meats, tamales, <br />1/1https.//mail.google.com/mail/ca/u/0/#inbox/QgrcJHrtrSdPnbjqznTcSkQxmWGFGKpBSrq?projector-l&messagePartld=0.1 <br />7. <br />8. <br />1868 E. Hazelton Avenue | Stockton, California 95205 1^209 488-3420 | F 209 484-0138 I www ajcehd.am <br />EHD 16-02 <br />07/3/17 <br />SANJOAQUIN <br />f ----COUNT Y----- <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION ; <br />A,M».«» — ■ ■“ “’J""-i <br />1. Name of Event: QSr. - <br />The following is Information about my organizatlon/business. ’ /0 ( <br />Name of organlzafcn/business: <br />\AT Atvscr> , y^rtin --------- <br />Phone: ----------------- Alternate: (L^ ) <br />ur ttci—nr) s.rv>AuHnJhg^ t i <br />™ to beai»n <br />I am providing food that Is NQI Prepared at home: Yes Cl No <br />All food is prepared on-site or is from <br />Name of facility: , <VY <br />dust and the public) <br />□ A booth with walls and ceiling const™^ of ®[ wni^is^have almooth^nd delnable floor (concrete, <br />“ZM^ndS Xd «blVand constructed to separate food and food preparation <br />areas from the public. <br />pother (specify):. -----------------------— <br />Approved bottled water. <br />1$ On-site hose bib that is connected to a potable water source. <br />^‘Zldln^n SSSXre the hot and coid hoidlng of potential hazardous <br />t hoW,nB a" P°lenMy haZard°US ab°Ve <br /> camp stove Q stemo & hotel trays <br />S Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />Note- Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products.