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<br /> S Q N J O A Q U I N Environmental Health Department
<br /> TEMPORARY FOOD VENDOR'S APPLICATION
<br /> 1 '.avf vV",1k1- tbotr, for wulit and r1pr1-PrOfIll are required to returr a Signed and ron,pleled fupy of ihl%checkl151 U}
<br /> :rya INSS►<l i-M)"djIlAtelr three(3) weeks prr[1r r(] this evenl
<br /> f\.s1*s1+ :1f Event ._ � '�^ a Dams).
<br /> 'r%P t04nw'nd .; ,nformatw)n abnul my arganlzallnNhuslness
<br /> Aare of ofqaniZa1ior'L bu&ness ]��Y 4.4� w� r\�,,�, ` 1 ...f
<br /> Address
<br /> s�t,ano f �C� ► 1Y!_' �t'� _ Alternate
<br /> a 4-
<br /> Lisl !oodloWclaorgivontothepubiic �h Ups
<br /> aril tuovldrng ftxid that 1:.NOT prepared at home Yes No
<br /> All foon 1s prepared on-srie or 4s from approved commercial facilities. Iyes No
<br /> Name of faerl,ty - — phone { —J
<br /> AOfk r355 ht F,ir a ht Y _ __� _
<br /> am provldrng a tx-oth with the following. Ito protect my unpackaged food and food preparation areas from flies•
<br /> dr+st anti the put*cl
<br /> )LA bmth with wails and ceiling constructed of either wood, canvas. plastic, similar material and fine fresh fly
<br /> nrng, completely enclosing oper food areas If w1l also have a smooth and cleanable floor {concrete.
<br /> awhalt. clean tarps and smooth wood are acceptable) and constructed to separate food avid food preparation
<br /> =irbas from the putal,c
<br /> Utnei ispecdy�
<br /> NoW "the only operations not requtfed to pfovioe enclosed poolhs are those which sell beverages frarr,
<br /> approrhd dlsDensers of prepackaged foods from approved sources
<br /> !Azip'uvea wvaler to, [Ninking utersli and hand bw-,pfovfded r, ny tly ffr,', to Ip.:•,nr,methods.
<br /> hpry+ed Battled water
<br /> I ��J�•-`.riF' hose hltJ lf"al vs Connected to a putar'
<br /> 0% Wt)nded for my booth's use l r j ! ----- --
<br /> H I or'- trrrw)-ri :srr, accurate probe Ihermr,r Fir r ,�.,'.i". .,� •r,r� ro,r Ir1 i1Llut.r'ci .,,f IH'1ier, v�v i,-arCOUS
<br /> ,r.,s1:0&f,!j Jkli ttrrle%of t"Ah(4)ttmN i,
<br /> :rn Idrj/K]rr,r} 11w!1011ow no f.o1 lemlWtralr 1• ,;Gnt"A 114r ill:. r rn f Grli: l :,11 111&-f,r n ,' t, 4:.'tr-falh f.
<br /> 5lferno R '.:40 11r1V .
<br /> fYn.fltrr .11r it sJr lTllrrrir 1,111, r, i .
<br /> r y ,�
<br /> Ftctcrrlr_sltrot rr4. ry(1 (�Itrl1 ft,f"-1 if'11 4t
<br /> Mat: Examples of potantlally/harardous four! 111cfurlu meats t:lrnialos Cooked be.111s. rice.
<br /> wegetablos,potato salad,e"s,and dairy prudtrrts
<br /> �'1r., l 1i:,fr�i1l/fl t,1••rn,r � �.Ir,t rb. 1 r . ! I
<br /> i i.1 14
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