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1 <br />san mom <br />Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />->lif ’.>9 3-i -U <br />7. <br />8. <br />05 [ f >09 •- <br />Page 7 of 11 <br />[ <br />!3(?8F l iyzo! <br />EMO 113-02 <br />06/2Bf2a?3 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) <br />/Vtvy <br />) __ Alto mate: ( <br />k,,’< <br />liar <br />.6 I j <br />the festive! coordinator three (3) weeks prior to » e'en,^ ,O 3 Si9"ed C°Py Of <br />1- 1Name of Event: QWi Dale(s): <br />The following is information about my organization/business: <br />Name of organization/business:Cn kf f u J / <br />Address: I "7 M H / < j <br />,17? - (, <br />List food to be sold or given to the public: . <br />~I Yes Fl No <br />imercial facilities^3 Yes No <br />Phone: f ) <br />the hot and cold holding of potentially hazardous <br />1 a,T P^01^ "’e snowing hot temperature control for the hot holding of all potenliaUy hazardous foods above <br />Camp stove Q Sterno & hotel trays <br />Double steamer Q steam table & lids <br />Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at homesQ <br />All food is prepared on-site or is from approved c^rnmi <br />Name of facility: 7 - <br />Address of facility:.~ kX~\ •'S — <br />1 admus7and toe pub7c')h unPacka9«j and food-preparation^??^^ <br />areas fromTe pubhc acCeptab,e) and instructed to separate food and food preparation <br />P Other (specify): \aX <br />Note: The only operations not required to provide enclosed booths are those which sell beveraoes from <br />approved dispensers, or prepackaged foods from approved sources. ' 9 ’ <br />Approved water for drinking, 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 />HOther (specify): Vp JJ- \ <br />/Electricity is provided for my booth’s use: Yes No ' <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: [3;Yes No <br />I am providing the following hot temperatur6 control for th ’ <br />I ,■ •'-(I <br />TEMP EVENT APP <br />.