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• -W ■ . ?ak-. w <br />Environmental Health Department <br />'/ >’-'24 <br />Da^s’/. <br />5.1 .Namo of EvwiL <br />2 <br />Address: <br />• 127-44’i <br />3. <br />4. <br />5. <br />lo P’ovce onttooil &oclh» <br />6. <br />9. <br />Unilea, cooked boint, flea, <br />Not* <br />7 <br />ft <br />Mato cf oTjanza^cnbuinaM: <br />l*O!i MamI.’. C*. V<h!C5V>C.; QS)>3 <br />Th* H IHarr-tfCH abo</ my crgartrnt^b.iihicat.. <br /> Rl u'i B'Slto <br />a*aas ton* <br />F 7D9 4C4 0^ 1 ww* *\WItu* «V»»CA/V,woE. HaWivnAvommI euxMa". 1 <br />‘ i <br />‘ ' s <br /> <br />O c<h< ------------- ------------- <br />. round Io p-ov«e twclh, ■>'« «'«» w«»' ••«• ,rc<r' <br />NOto: ?£££ ^r«or.. « f«x<. from <br />watortor^rc ^f-lfbo^fr royt^byth,^ <br />3 wtta'- <br /> 0,-oho hOM! Ma lh»t l» eoonoWKl lo o pcl»blo *»l»r «•««>■ <br /><<5,“ ^ha °’ t>‘”'“n w <br />, k tM ™ of ... oofor.U.IV n.zadou. foed. .Uv. <br />nXmpWy. rJSWnoAnoMlV.y. <br />npoubfowme. bdSM.an.tatH.AW. <br /> EtodrsattvatoP CJ ot*> (’P«A> <br />ExamolM o< poleMlally food Includt: <br />potato wtod. •flO®' pro^uet®. <br /> <br />Pncro: ( 2C 3 J <br />Us! feed to be scM c< flk^n ta the p-bfc: <br />I am pr&vklirbg !dc<5 thol b NPTj,’nfM,r0^ «lhcfre;G] v®# -J N0 <br />AJi VxJ It jyepamd on sho cr Is torn applet ccm/notdal fadPto ?> Yet U o 946.9y , <br />NamooffmW- El ----------------— ---------L" ' ~ <br />4 717 gfkifhll Hlvfi Onklard CA 94601, ------------—IXXc(iopcotaMmy^^^ <br />euat »r>d the pubic) <br />E A booffl W’h WAlta ord wlha conkVUOtaH Cl «ll «( *««. «£«• ^'^oa^7’d Cta^le (ccrcreta, <br />Xu SXU « «P-. and t«p.r^ <br />wnAh tom Ito E*jnrc. <br />X SANJOAQUIN <br />I ------COUNTY------ <br />,#.*'' Grrntnru ij^dwi Arie. <br />TEMPORARY FOOD VENDOR'S APPLICATION <br />A! Axd venftra (both for prt/l and rwn profit) are reedred la rnturr u sljhnd s.nd ccir.pte .«?1 copy of <br />lf»o teiitva coorohaicf three (3) week® prior to Ihb ©verl. <br />HistoHc Htnlaqe <br />_______ __ AJtMnaic: ( )----------------——— <br />I b’rn •■'. Nixdlcs AtfuDU b' •!>l1 fAir.uh—^-J1'-*0' •••!_£---- -------