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- 07-21-2017 08:46 P0DESTOS r 7518601 PAGE1 <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />P»8#74<11 TEMP EVENT APP <br />_ anizatkxVbuainesB. _ <br />I U/J (aJ Gas <br />UrtfoodlotiaaoMwnlvBnloBieDuMc; | P-( <br />fMttval coonttiator three (3) weeks prior to this event. <br />1. Name of Event:....i <br />EHD 16-02 <br />0M1/1B <br />required to return a signed and completed copy of this checklist to <br /> <br /> <br />-7^7 ^/r? <br />**18 fr®^PProved commerutal facilities: Yes No <br />—■_________Phone: {i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />.«* 5™r-- - - ->□) weeks prior to this event 1 <br />/1/0 Co I a* U _____ <br />The foltowing is informahon about mvonlanizatton/butiness^ / / - <br />Name of (xganizatonfousirwM. _____________ <br />10^/ ?<SYjg57 <br /> _ AttamatH: (7^) Z-^S,6 O / <br />I am providing food that Is jjjQi prepared st home: j^Yes No <br />AH food is prepared <br />Name of facSty: <br />Address of facility:_ <br />* adustand the pub^ totowin®: P™*001 my unpackaged food and food-preparstfon areas from Has, <br />OAbooth with waHs and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />sa^6nJn^! co^Pktely enclosing open food areas, It will also have a smooth and deanabte floor (concrete <br />?!pha/ c>0.an ”?* an<’ smwth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. * a <br />^(pther (specify): <br />Note: The only operations not required to provide enclosed booths are those which sei beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing win be provided in my booth by the foilawing methods: <br />^Approved baffled water. <br /> On-site hose bib that Is connected to a potable water source. <br />Q Other (specify): ....................................... <br />Electricity is provided for my booth's use: Yes ^j$fo <br />1 SE™ <br />1 foltowlng hot temperature control for the hot holding of all potentially hazanfous foods above <br />U5 r* <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & Ids <br /> Electric stove top 'pother (specify) ‘'B* & ' <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans rice, <br />vegetables, potato salad, eggs, and dairy products.