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SAN )lJ � lIN I •!iN!!'f1i)111f�11��11 `"#f!:Jill) I)r•�1'[m.trill IIt <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Al! ,'u`.1 L Ilan :,tlm!ll fol ploill mlcl Iloil-Inofll)lilt'.ft'(pilred to re'tllrrl a 5Nplerl I11<I r.flrllpl9tre(I r9py of tlltr.Lher'`I <br /> !Ir Il :•tr. 71 ,rrit71,1t( iltlC7t(.�)1'rrrk:.Iviurtothiso-Will <br /> } N c71r1 of 1_L'7`rll.71 t <br /> The Rollo.!! g i;•InfollTlollon nhout illy OlgHniL itlryR/13uS1f1(,55 <br /> I <br /> Namt,otarrttlruzaho+17t7llilllC5$ - � �I" • � SUrf t�(! <br /> Addiess _ � .,7 J1:�!ytJ -- <br /> Phone Allernatfe'( <br /> t List fond to be sold of glvrll la Ute public ib�f � �Qs=1 V_tJ'� ^'—.. ---- <br /> i I am providing food that is NOT prepared at home I]Yes N No <br /> All fOof1 is prepafef[on-site or is frons approved cumfilercial facilities:0 Yes{"�No � <br /> Name of flaelflly. _t....4.UVL)Adt, WtJ e �' __ Phano: L.)Zkf 7—'z _— <br /> Address of farilrly. �AlLc4tl a.— Vim, <br /> 5. I and pl0vidntg a banlh with the following'(to prolerl my unpackaged food And food-,ifeparalrnn areas fruml flim <br /> dust and the public) <br /> ❑A h0o111%lith walls and Ceiling Corlstrucicd Of eilher wood,canvas,plastir.,similar malerlal loci line m^ah fly <br /> screening, cornplelely enclosing open food areas It vlili also have a smooth and cleanable floor (corlcfete, <br /> asphalt,clean tarps and smooth wood are acceplabie)and constructed to separate fond and food preparatico <br /> afeas from 111e publir.. <br /> I_I Olher(specify). — <br /> Note: The only operations not required to provide enclosed boollls are those which sell hevora(ges from <br /> approved clispensefs,or prepackaged foods front approved sourceG. <br /> G Approved water for drinking,utensil anrt harlcl washing will ho provided in my boolll t,y 1110 fotlevring methads: <br /> ❑Appioved hotlied wider. <br /> ❑on-site 11050 bib Ihat is connected to a potable(,wator sour(:(,. <br /> U(tler(specify): �� <br /> 7. Electriclly is provided for my booths use-[]Yes'X'No <br /> h. I 8111 providing all acauate ISrobe thennomet(a+ to pleasure lite [lot and cold holchnfj of potentially h,11VIRIg115 <br /> foods during all Groes of hoalil operalinn;IJ Yes I I No <br /> 9. 1 L.,111 providing tile.follol�419 1101 tr-Illptlrature cclnlrol for Tile hot holdim 0f a[I potclntially hazardous foods ahove. <br /> 135'F: <br /> I Camp stove I]Stento&hotel[rays <br /> f�I f]Otr13N steamer <br /> ❑Stoom table S lids <br /> f`Ic:cUir:stove top <br /> IJ Cather(specify) <br /> Notc': I"r.:a++ples of potentially hazar(101115 food inrlutle: 1110-Its, tartlnles, rtaokatl tle.tlts, rlc(e, <br /> yr;it tclbl0s,polata salad,uggs,and daily products, <br /> fitfiL4 I I lotcltofl llvenuta 1 Star,Edort,f;aGklrrtin 952�1C>ir1 T1209 X168-31201 F 209 464-Ol:10 1 vAm sj solid, fillsH11 nrl' <br /> ura,lu <br />