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Date(s) 10/18-19/2025 <br />2 <br />cX\ <br />4. <br />w <br />5. <br />6 <br />9 <br />food include:meats, tamales,cooked beans, rice, <br />7. <br />8. <br />I www sjgov org/ehd <br />TEMP EVENT APP <br />SAN IOA0UIN <br />C OIJ NI > <br />06________ <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />X"110 ,'?h,,n 8 SIB"ed and “mpte'eri “pv of cnecKNM ,0 <br />1 <br /> Alternate: ( ) ___________________ <br />SoAcy i-fmOrtadCi cua^r <br />i Name of Event Clements Stampede <br />The following is information about my onganlzation/business: <br />Name of organization/business: X)1V | Ll C\ <br />Addr“s ' Q ciV c\q\< <br />Phone: (20^ ) 2^3^ <br />List food to be sold or given to the public. j ~2C? Q ( <br />I am providing food that is NOT prepared at home: ^Yes No <br />All food is prepared on-site or is from approved commercial facilities M’/es WNo ( <br />Name of facility: k <br />. ---------------------------------------------------- -----------Phone: (____)Address of facility: <br />dust and the public)1 With f0ll0win9' ^t0 Protect my unpackaged food and food-preparation areas from flies. <br />'JoodlreaV^^^iso 8^85 PlaS"C' material and f'ne meSh <br />asphalt, clean tarps and smooth wood are acrentahi^ Jh ° a4srnooth and cleanable floor (concrete <br />areas from the public. P b e and constructed to separate food and food preparation <br /> Other (specify): <br />Note; <br />Approved water for drinking, utensil and hand washing will he provided in my booth by the foilowing methods <br />^Approved bottled water. <br />■^On-site hose bib that is connected to a potable water source. <br />U Other (specify): Electricity is provided for my booth's use: ©Yes No---------------------------------------------------------------— <br />foodPs during all time^o7bomh^peratonnKYe,sOeNoUre h°' ““ h°ldin9 °f Potenlial|y hazardous <br />I am providing the foliowing hot temperature controi for the hot holding of all potentially hazardous foods above <br /> Camp stove sterno & hotel trays <br /> Double steamer Q steam table & lids <br /> Electric stove top QuOther (specify) <br />Note: Examples of potentially hazardous <br />vegetables, potato salad, eggs, and dairy products.