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Environmental Health Department <br />‘i/ >o/ z 3 <br />< i_____Phon* <br />1 <br />a <br />mails, UmilM, cookad baana, rica. <br />UM fcoa e ba acai or gNan to «w pitte <br />□ »am9»holairiys <br />□ taamaMtMa <br />□ £»>«■ (apacrfy) <br />Not*: Eumpiaa of poMOaly haxartoua food mctuda <br />vagataNaa, potato salad, aggs, and dairy products <br />F Hazard I SaxMon. Ctofamia 952051 T 209 4M-M20I F 209 46-1-0138 ■ *w* <br />IL**! <br />!"r«™ prat hu< <br />TEMPORARY FOOD VENDOR S APPtlCATON <br />copy o* >*■» cr«c»,n( to <br />1 IMmtf Loz‘ ___________________________£ <br />a Tba ttooxng a rtsmom mxm m, --L-------- • —t <br />Nama d orpanttasoVb,j»n»M Jrl.,-rot <br />AOdrssa 7^ ^rr Li-* <br />y-f f-crg. n Ntons4l’'"2L- <br />4. lampnMdmotoodtaf NOT tssoarad M boms. Fl Yus <br />Al hod to prsparadonato a Is tram appMdoonwiwnM tacaaaa □Yaa0Ho <br />Nameortoctoy.Pnona I 1 <br />Addrasa or Iscaay.________________________________________________________________________ <br />I am prwSng a booth wWi tha tolowing (to protsel my unpadugsd faod and tooc-prucarabon araas frcm toes <br />dust and the put*) <br />Wa boon wttn wala and caung conutructod ot mr wood, canvas ptoaac. abniar maasnai and tow mean tty <br />Bewung. comptototy enaoamg open food araaa n w« atoo have a amooai and cleanabta Doo. (conowe. <br />aophaA clean tarps and tonootn wood an aocaptabto) and conswctad to saoantoe food and food weowsoon <br />araaa from the pubic <br />□ OCW (speedy) --------------------------------------------------------------------------------------------------------------------------- <br />Motoc The erty oparMtons not mqund to provsta anaoaM booms are toaa snm ess ti angil ktaa <br />appmved aspensers. or pratmcMesd foods tram approwd soucaa <br />Aporrmd watarkr atotong. utenaa and hand wshfog «■ ba troMad In my boan by tto tatoa^ mapiode <br />□ Approved botbadwMnr <br />JSXbruKt Mae Mb Mt to connecsed to a polable water source <br />□ OMrlsoerfy): ___________________________—------------------ -------- <br />tootodumgal tones of boom opereaort p^wD Ho <br />g I am pronang foe lo*OMng Mt terMOraaiVebnarot lor M hot bofong o< a: pcimM-iy Martous foods atoeae <br />tJ8V: . ’ <br />□ Camp Mon <br />□ OouMaMnw <br />jjfttoceto se>a top