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--"------------- <br /> SAN MpN Environmental Health Departrnti:nt. <br /> - l <br /> . i <br /> TEMPORARY FOOD VENDOR'S APPUICATION <br /> m food vendm(Dash for prom and noi4xoM)arn'rogulmd to return o m9ned and completed copy of this chec"to <br /> the fes"coordktata'throo(3)wooks pdortt to this ovant. <br /> i, 1.Naame o1 EvM, <br /> - i <br /> ormatiore.at)MA my.orsya*atlorvtwwrtess;Name o}orgar�ization/bua__ines_s: _—_ - - <br /> .. O`( Rf1 G.vti Y t; r S.5 - <br /> MOM ,log, u4:�5 IIa <br /> 3. L.isl f)bd to be-wM'or to the bfic: r•k\\� Alternate: ( } <br /> -4:- I am pratddurig food that is NOT prepared at horny l d yes❑NoAN food is prepared on-sde or is from approved commercial faralkies:[.7Yes No <br /> fti[arrre of facility _C1r+ru Phone_E ) r <br /> /address yf roc jr .. . r1- -S .' L - 5 <br /> K �azn P a booth wrsth 9tie fatl6wing(tapio ' mynnpackabed toad and food-preQaraSnri aeashmn tFies, <br /> �� :-- ttusfax)dtYre-public) .. _�-: -.. _ --• . - --,-_: --- _-.._ _ - <br /> (]A boofn Wth wags and ceiling,constructed of-either wood, canvas,plastic, similar material and:fe.mesh fly <br /> sareening, completely endosing open food areas. It%Wl also have a smooth and cleanable i oor(concrete, <br /> asphak,dean tarps and smooth woad are acceptable)and constructed to separate food and'fbod ftrbparatiton <br /> - -areas from the public. <br /> 0 Dthas(spry): <br /> Note- The.only-,operations not requiied to'provide enclosed booths are those which sell beverages firm <br /> approved dspemers,or prgmc kaged foods from approved sources. <br /> Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods:" <br /> Q Approved bottled water. <br /> ❑Orr-sAe hose tiro that is connected to a potable water source <br /> ❑Other(cy)- <br /> 7 tedricity is provided for rrry booth's use:0 Yes FINo <br /> 8- - 1.am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods dtffnng all limes of booth operation:❑Yes[]No <br /> 9i_ l am providing the falfawln_g hot ternperatirre.,c�r_ihe hot holding of all potentially hazardousfoods.above . <br /> []Carp stove steno&hotel trays <br /> 0136u418 steamer 0 Steam tabled,lids <br /> ❑Electric stove top El Other(specify) <br /> Nafe:. Examples of "ntixily hazardous food include. meats, tamales, cooked beans, .rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> i GB E_Hazeflon Avenue I Slockton.Califomia 952051 T 209 468-34201 F. i'09.464=0138 j Viiviiw s�ov_otglehd <br /> EkD 16,fll2 Page 7 d t1 <br /> Afif19ri4 TE dp NMT APF <br /> ,�'4 Inc <br />