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3 4 57 <br />S.A\ IBAllIJIN <br />1 EMPORARY FOOD VENDOR’S APPI IGA 11( )N <br />Vu. .-I Vd? <br />lAAcotVSS <br />3 <br />3 Other tspecify> <br />Approved /.ater for drinking utensil and hand washing will be provided in my booth by the following methods <br />X Approved bottled wafer <br />Or site hose bib that is connected to a potable water source <br />11 'it | i ’ii'l ■:< <br />Note The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers or prepackaged foods from approved sources <br />' : t>»ub!' <br />r~; <br />:> .■‘irv-r <br />■ ' tOp <br />. f.- < n nt! is infonnalion .ibotil my «>ti).»iH.r.»li<)n;hiiMn<>i,\ <br />\ • ■*«' r! .vg.inirahotvoiisiness <br />>1 •- Q<jQ>cl S <br />■ 4'V ■ <br />3 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening completely enclosing open food areas II will also have a smooth and cleanable floor (concrete <br />aspnalt clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public <br />'i 'f y i <br />' ’' '■ il’i >1 ii '■ ‘i pi-'? it J'v'i non pi of tt) me ii'ijmi m I tn i« •! inn , i '.hiiioiJ (uul • • >'rij>l< •'< <1 tl <br />■ ' '' ‘ ' i'fiAhv Th(ro (.n Uf-»o; pt WM . tlir. ovprit <br />Hutt I /ample’, of potentially ha/anloiis footl include: <br />vi gflablus. polato salad. and dairy piwdnut?.. <br />I It VII 'OllllMMlbll Hc.tlth I M f t, <br />3.4-1 sy <br />Alternate ( ^>6 <br />st foi'u to be sold or given to the public clyiden /'W6 . <br />rr, ptoviding food that is NOT prepared arnoino |^] Yes [. Jhlo <br />a *eod is preparedfon s11.<)or is from approved commercial facilities j/l Yes I I No <br />Name of facility Phone £) <br />Address of facility _________ _________________________ <br />. am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />Other (specify)___________________________________________-- <br />• • • is t.i'.v! icd for my booth’s use I 1 Yes fed No <br />. : m/idmc ar accurate probe thermometer to measure lhe hot and cold holding of potentially hazamous <br />during all times of booth operation M Yes L ) No <br />;■ • jzoz c ng the following hot temperature control for the hot holding ol all potentially hazaidous foous .it\".c <br />(X St er no A hotel trays <br />| | Steam table ,i lids <br />I ] (riluri (specify) <br />meats, l.nn>ilos. * ookod tM>ans. ru «• <br />’.Uz.i b ii ' .jlrfomi > 'i' /u*. | | <l'i li). <br />--------- --------H«-J" / •>* ’ ’