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J <br /> 14 j I W I <br /> I t a I <br /> TEMPORARY FOOD VENDOR'S APPLICATIOIN <br /> kx,ilrtati?r 11 11,o i i,ri,,, to hl5 ov(%ni. <br /> inforniation ahout my organization/business: <br /> (43 C 0 Nanw <br /> 3-731 _S-rm.:ff�e-T EA-Sr L1117LE120CAC <br /> Wre"s CA c(IS 43. <br /> o to- Alternate: 0398 <br /> List food to be sold or given to the public: L_L#"0NA0F_ + '354n.0 _r" A <br /> I am providing food that is NOT prepared at home-[�(Yes 0 No <br /> All food is prepared on-site or is from approved commercial facilities:R<es Ll No <br /> Name of facility: C)W St-re Phone: <br /> Address of facility: <br /> I am providing a booth with the following:(to protect my unpackaged food.and food-preparation areas,from flies <br /> dust and the public) <br /> __/e'!.,..I A booth with walls and coiling constructed of either wood,canvas, plastic,similar material and fine roosti flv <br /> screening• completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete. <br /> asphalt. clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> nreas from the public. <br /> F__1 Other(specify): <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 /> /Api7,rQvPd water for drinking,utensil and hand washing will be provided in my booth by the following metoocis <br /> Approved bottled water. <br /> hose bib that is connected to a potable water source. <br /> i(jlt-(-r IspPerfy): <br /> (.ry;s provided for my booth's use.M Yes n No <br /> Irn ;,mviding an accurate probe thermomeVto measure the hot and cold holdiny kit po�c <br /> elunng all times of booth operation:[Z Yes El No <br /> i,!,j,jrf:ng the following hot temperature control for the hot holding of ail potentially tm., <br /> Sterno&hotel trays <br /> J,le steamer El earn table&lids <br /> ot <br /> love:lop -9 ,er(specify) <br /> Notc- Examples of potentially hazardous food include: meats, tamales. cooked boans. <br /> vegetables,potato salad,eggs,and dairy products. <br />