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SAN 10AOUIN fciivironiiic-ritdl Heallli L)pp;n IiihjiC <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />?In-? following is mfonnalion afoul my org inizalion/busifimis <br />A< b I <br />21U’ • Phone Allernak- ( <br />L iSI food io be sold or given to Iho public i Capnn.Pi P-Gl IS ♦3 <br />•1 <br /> Olh .r (hpet'f> ) <br />Ai mc .ed water fur diin^mo ulonsil and hand washing a.II t>e piovidod in my Ixoih t >■ the ov. - ) iT>e:i ■ d»(> <br />'j <br />'I ” I II ' '■ <br />f' <br />Note, lhe on'y operalions not required to piovide enclosed booths a»e Iho e wh.:ti se'l th:.,wages t'c.m <br />appro/ed dispensers nr | repa I.aged Io 'ds frorn approved sources <br />Nawo ut organizaiicwVlnijinrsf. tendon <br />.93^^ ^A. K<-1 ______________ <br />l ?m p'ov a ng food that is NOT prepared at ho-no O '"'es No <br />Ai> food is piepared on srio or is from approved commercial facilities D^-Yes f l No <br />Name of facility Phone (_i <br />Address cl fa.-ilrty__________________________________________________________ _________________________ <br />I am p ovif i.. booth with the following (to protect m/ unpai'kagcd food and toed i reparaton fir, . fl <br />dust ar .1 the pubi c) <br />7 <br />8 <br />(>j A t aoth with walls and ceiling constructed ol either v/oud canvas plastic, similar material ar d i no me-.-n t,., <br />screening completely enclosing open food areas It wll also have a smooth and cteanabte floor ;e’.’ <br />asphaii clean tarps and smooth wood are acceplabkd and constructed Io separate food arg f.xxd pr< pe <■■ ?■> <br />areas from the public <br />[7j A|>|Xuvt J Ixrtlled wdlui <br />[I On srK: t.. >e l‘iti Ilia! is i.uivi';' li.d t'> a polable waler souita <br />Noto: Ejramploa of pulcnlially ha/aidoun food liicludo: <br />vegetables, potato salmJ. «qgr. end dairy products <br />All food vendor*, (both Im profit nnd non piolil) are tequirod In return ti signed and rompluk d (.z>py of Un* rd ‘' I-I l lo <br />the tesbvat r oordmalor Ihme (3) wooks poor to Uns ovent <br />incaln, Inmates, cooked beans, rue <br />1 iou.r^clcw/ <br />I Name of Event Lucy Cc» h ] rir i rtf's f-V \r 1______ D.jtnfsi G-HOM) <br />: I II <br />f.LJ <br />I ■ t;..| <br />I______________________ <br />1 -;|r f >En i <br /> Other (ep<‘< rfyi------------------------- ---------- ------------------------------------------------------------------------ <br />t.lxtrii ily r. |.iovidr-d for m/ booth s use I I Yor. I/J No <br />I am provrOnig an acajrate probo thomromeiQr to rnc i rro the hot and cold tioia »g o* po! ■ I'fy t u a d u <br />foods during rill limv'J of buulli opemlir.n |/| Y> No <br />I am (ruviding thri following hot l»-rnp.!i iturn t ontiul h>f Ihn hot Ixrl.lin > of nil potr nlciily i • •. rdcus food • at?. .<t <br />1354 <br />|zd Co up stove LI St- moR tiotol trays <br />Q Ucubte sinamc r IJ 1 ’b*" **f3 <br /> f. k« irr. slow lop I J ‘ Hhor Isp* < -’y) <br />1 <br />> < i