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Environmental Health Department <br />1. <br />Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />7. <br />8. <br />I Ural, <br />SH, SWKovi '|Aft Qy-^cz <br />/7 Ar Ma <br />OdOcShv ntj'V <br />—0 b b |_________ Alternate: (^ci ) <br />Hoi pQgs JOac^os_________ <br />I am providing food that is NOT prepared at home: [3-Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0. Yes No <br />Name of facility: _____________________phone; ( } <br />Address of facility: <br />' teTandtheputfc)1 Wi‘h f0"°Win9: (t0 prOtect my unP^kaged food and food-preparation areas from flies? <br />^reAeni0n0QthromnSh,and f6^9 const™c?ed of either wood. “nvas, plastic, similar material and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete7 <br />lX^rom7hVp7bncand Sm00th W00d are acceptable) and constructed to separate food and food preparation <br /> Other (specify): <br />Note: only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />® Approved bottled water. <br />S On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: ©Yes No “ -------------- -------------------------- <br />1 "rs." ™" ,ta “ ■M ““ a ““ <br />1 ^^idmg the following hot temperature control for the hot holding of all potentially hazardous foods above <br />0 Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />SAN JOAQUIN <br />-----COUNTY------ <br />Greatness grows here <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />tah: zrd to return a signed and comp,eted copy °f this “to <br /> <br />1. Name of Event: HoV ly <br />The following is information about my organization/business: <br />Name of organization/business: q/ Ale P\^St4/Tlf)hl <br />Address: Ob7-? fc VCoiShvntiiCM <br />(90^) W - <br />List food to be sold or given to the public: <br />Hazelton Avenue I S'^ton, California 95205 I Tf209 468-3420 I F 209 464-0138 | www.sjgov.org/ehd