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■■■■ <br />Environmental Health Department <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Date(s): 1 .Name of Event: 1. <br />2 <br />fA Address: <br />3 <br />4. <br />5. <br />6. <br />9. <br />tamales, cooked beans, rice,meats, <br />7. <br />8. <br />|Hazelton Avenue | <br />SAN JOAQUIN <br />COUNTY <br />I am providing food that is NOT prepared at home: Yes 0JJo <br />All food is prepared on-site or is from approved commercial facilities: I^Yes No <br />Name of facility: Phone: 11- <br /> <br />famTro^ding abooth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />gu tooth with walls and ceiling constructed of either * Xabte <br />XphToie^6 and"sCmooth wS are acceptable) and constructed to separate lend and food pieparalion <br />areas from the public. <br />stockion. California 952051 T 209 468-3420 |F 209 464-0138 | www.sjgovWehd^ <br /> Other (specify):--------------------------------------------------------------------------------- <br />Note- The only operations not reqcred to provide enclosed booths a™ those which soil beverages Irom <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for dunking, utensil and hand washing will be provided In my booth by the following methods: <br />"^.Approved bottled water. <br />^On-site hose bib that is connected to a potable water source. <br /> <br />SSfcS XSomX'rTXure the hot and co,d lidding of petentialiy hazanfous <br />, XX °' °he hot hoBin9 a"p0,en,i8lly haza,d°us ,oods above <br /> camp stove Stemo & hotel trays <br /> Double steamer steam table 4 lids <br /> Electric stove top O other (sPeclfy) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />The following is information about my organization/business: <br />Name of organization/business: A <br />Phone: (Q-O<^ Alternate: ( ). <br />List food to be sold or given to the public: