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FROM FAX NO. in. 23 2013 1:37PM P7 <br /> SA .-JOANIN Environmental Health, Department <br /> TEMPORARY FOOD VENDOR'S APPUCATION <br /> AU food vendors(both for t aW M ae required t(>turn a <br /> the feSbv ,ed arid c�orrgateted c:apy of this t to <br /> al cootdi�or fteeA3)wed prig to tfeis everrr <br /> g. 1.Name of Even �-- <br /> Date(s): �l <br /> 2. The fnuowing is information abolA my ffordbLobx=: <br /> Nanwe of omwtm ness- <br /> Address: <br /> Phone: ( ) <br /> I List flood to be sold or giver►to the pubGG <br /> 4. l am providing flood Chats NOT prepwW at home <br /> s <br /> AU food is prepared on-Ste or is frnrrr approved No <br /> Name of facYw ` <br /> Phorta_ <br /> Address of facdity_ a} �.� - e ct <br /> : 5. 1 am provitiing a booth v h the"owh-0g:(to protect my food aid <br /> dust and the plc) d�r+�araCron areas from des, <br /> 0 A booth viwaA welts-at�d-- -- <br /> L4 corkstrucfor of etrtier i ca wa% _ffWMW and fare rn-eal vy. - - — <br /> =eenhg, =9"etx* t OPen food aV2S- if wil also have a sntiooth and <br /> araq*taft mean t and soh wood are aecq )aid cor d to Sqm rata <br /> . ❑other( r- <br /> Nobs: The only operalmm not requalad to provide enclose@. booths are the-which elj <br /> OPPmved�.of prey fps� s from <br /> 6• Approved water for drip ,uberaand hand INIIstag 194 be wed in my booth by the-WJUVAV me1bods: <br /> �]Approved bott;&d water_ <br /> [�On-$ite hose bib that is connoted to a potable watem socuoeL <br /> ❑Other(speciry)= <br /> 7. !E m tfi*is �for ray booift's use: Yes©No <br /> a <br /> an accurate P�twmmrneler to mama the ha and mid tmlcwv of <br /> 30Od6 during au Clines of booth apej�0 yes p No <br /> 9, 1 am providing the Ubwing W tm�re c umd for the hot hokrgrQ of afi ply hmwdom foods above <br /> 1359F: <br /> []Camp stove P Stemo&how trays <br /> []Double streamer ❑Stgam table&lift <br /> ❑Ele�stove top ❑Other(specify) <br /> Nat®: Examples of potannagy h=wdous food include: meats, URMISs, coO ` Means, rice, <br /> vegetables,PObiD salad,eggs,and daisy products. <br /> 4'OCO L• ir�.��4- <br /> I2 - rs$.14, 12192: wwn.sjcem.comRece v e d r N 'o7rsr7 7 <br /> 3EW EVEW APP <br />