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_ Date(s): <br />^C> <br />Address: <br />) <br />3. <br />4. <br />5. <br />6. <br />9 <br />meats, tamales, cooked beans, rice <br />I <br />7. <br />8. <br />- <br />Name of organization/business: <br />StN lOMUIN <br />-----COUN~V----- <br /> Alternate: ( <br />o'^‘c2 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />food vendors (bo* for profit and non-profit) are required to return a signed and completed copy of thrs checkhst to <br />j festival coordinator three (3) weeks prior to^his event. <br />I o C- \ v------------- •1. Name of Event: <br />The following is information about my organization/business: <br />Environmental Health Departmen <br />,hose from <br />dkg utensil and hand washing will be provided in my booth by the following methods: <br />APP’ <br />Q Approve <br />CT On-site hose <br />^^/ided for my booth's use^ZJ Yes □ No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: M Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: r-n ~Camp stove U Stemo & hotel trays <br /> Double steamer Steam table & lids <br />O Electric stove top Other (specify) <br />Itoto; Examptee of potentially hazardous food Include: <br />yegetaMes. potato salad, eggs, and dairy products. <br />^n.C^S520pU?;f?9466.3420, F <br />Phone: ( b) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:r □>■Io <br /> <br />All food is prepared on-site or is from approv com Phone: (1 <br /> Name of facility: --------- <br />Address of facility:--------- <br />I am providing a booth wi <br />du£t and the pubiic) <br />screening, complete y srnooth wood are accep <br />asphalt, clean tarps aareas from the public. <br />y~\ other (.specify) --------- <br />UotC‘ ApproveddSJnsei.ori <br />,roved water <br />,ed bottled water. <br />bib that is connected to a potable water source. <br />food vendors (both for profit and non-profit) <br /><ax.