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I <br />SAN JOAQUIN COUNTY <br />enviormental he alth dep artment <br />1868 East Hazelton Avenue, Stockton, California 95205 <br />BnsineMi (209)468*3420 <br />prg-- sz to <br />Ojtert^eciO): t __ _ <br />mM'jimto probe thcnncoictw to i <br />t <br />-------------— <br />es i J l?’u <br />for the hot holding of all potentially hazardous foods <br />Dete(s): ^^-3 <br />111 fo d TEmp°RARY FOOD VENDOR’S APPLICATION <br />rW^rc^t0 rcturn a s’gned and completed copy of this <br />owing is information about my (vgamzation/buBiness' <br />Name of or^^an/burineM; <br />Addre”' r^1 tf»x /66 _____________ <br />1Ph0"c: ^2-222-?-.gyy/- Alternate; ^7 <br />List food to be sold or given to the public: <br />. I am providing food that is NOT prepared at home: [o^ Yes [ ] No <br />All food is prepared osi-aite or is from approved commercial facilities: [^Yes []No <br />Name of facility: Phone: 7^7-^^4- <br />Address of facitity?^^^ <br />. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from <br />flies, dust and the public) <br />M A booth with walla and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />mAh qy ficreeninfc completely emJosing open food areas. It will also have a smooth and cteanabte floor <br />(concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food <br />preparation areas from the public. <br />operations not requked to provide enclosed booths are those which sell bevwagto from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing wfll be provided in my booth by the following <br />methods: <br />r 10ther (fl>ocify): * , [ 1 No <br />1 proviMmij r ^Vm f 1 Nocon^to the hot holding of all potentially hazardous foods <br />X'135^F‘hren^‘DOTbtowmBr [JBfart-owwP