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SAN JUA011IN <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> i --,,a r,2qui-iej to return a signed and comple',ed copy o!V- <br /> irijt,)r I hfe.:a(3F r. s 1-r"�i i6'n s event <br /> . I <br /> Y75 <br /> 71-,e is inforr,?Mcin Pnout my organ ization/busirless <br /> Name of organT-ZGttLn.-bUSi11SSs t rr ks ru <br /> Adcfe3s. IWA <br /> Phone, Alternate: <br /> Us'mad to be sold o,3;ven to the ptiolic C <br /> I ani providing foc-d,I)at is NOT prepared at home.C3 Yes <br /> AI]fond is preriared on-site or is from approved commercial faciklies. 0 Yes[3 No <br /> Name of lac0ty. Phone:L2LJ kL:—')7 4L <br /> Address of faci!ity. C A (A 11-Z/>7 <br /> 5. 1 am pc-jid;ng a booth with thefollo.%-+ng (to protect my unpacKaged food and food-preparation a— <br /> dusl and the public) <br /> F7 A t=lh t.-Jth watts and ceiling consinicted of either wood.canvas, plastic,simil3r rnatcr:a1.&,11 <br /> screening, scrn-plet&j enclesmg open food areas it Vjilt also have a smooth and Clea..jabl= fjL� <br /> asphalt, <br /> Dhalt, clean tarps and smooth wood are arceptabie)and constructed to sepa.-a:L,food and fcoci.pr�-p---rat;on <br /> areas from lfle;Pubbc <br /> 0 Other(specify). <br /> Note: The only operations not required to provide enclosed booths are those which s=-'.' Leve'rages from <br /> aPproved dispensers,or prepackaged foods from approved souTcss. <br /> 6. Approved water for drinking,utensil and hand washing:'rift be provided in my booth by the folllovwing methcds-. <br /> []Approved bottled water. <br /> F-1 On-site hose bib that is connected to a potable water source. <br /> 0 other{specify): <br /> 7. Electricity is provided for my booth's use 0 Yes V No <br /> 8, 1 am providing an accurate probe Illernionieter to measure the hot and cold holdmg of potentially hazardous <br /> foods during ail tunes of booth operation:0 Yes E-j No <br /> 9. 1 at-n providing the follo,.ving hot temperature control for the hot holding of all potentially hazardous foods above <br /> Ll Camp 510t'e 0 Sterno&hotel hays <br /> Dotible s!ezrner ❑Steam table&lids <br /> Electric stove top ❑Cther(specify) Vill <br /> Now: Examples Of pOte"liallY hazardous food include: meats, tamales, cooked beans, rice. <br /> vegetables,potato salad,eggs,and dairy products. <br /> 8P)8 C i lazeRofl Avenue I Stockton,California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www Sj:ehJ.C'oj11 <br /> Np,7 0 E%'F <br />