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TEMPORARY FOOD VENDOR S APPLICATION <br />'hi InDate<s);1. <br />2. <br />Access: <br />Ptxxw: <br />K-JUst food to be sow or given to the pubic:3.T-^n. <br />4. <br />5, <br />6 <br /> On-Ke hose txb that «s connected to a potable water source. <br />-yJ)fUVv <br />7. <br />8. <br />9. <br />meats, tamates, cooked beans, rice. <br />TrVPEVW AFFPtQtrc*'* <br />Awxoved water kx dnnkjng, utensil and hand washing wli be p*ov<ded m my boom by the following methods: <br /> Approved botted wato’. <br /> A booth with waBs and celling coretruded of either wood, canvas, plastic, similar material and fine mesh fty <br />screening, completely enclosing open food areas. It will also have a smooth and cieanable floor (concrete, <br />asphalt clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the pubic. <br />Brother (specify): <br />Note: The only operations rot required to provide enoosed booths are those which sell beverages from <br />approved dspensers, or prepackaged foods from approved sources. <br /> Stemo & hotel Pays <br /> Steam lab* & lids <br /> Othr (spocxfy) <br />AAz>A< >Vo CA <br />Alternate: ( to*"/ ) N / U £ i V M <br />CHOte-tt <br />M food venders (both for proM and non-proAt) ar© reputed to return a sgned and completed copy o< this check st to <br />the fest val coordinator ttree (3) weeks prior to ths event, <br />1. Name of Event IcjU V SVclj. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control lor the hot holding of all potent alty hazardous foods rtx)ve <br />135T: t-i/K <br /> Camp stove <br /> Doubte steamer <br /> Electric stove top <br />•fzc <br />The following is information about my organ zatxxvbusmess: <br />Name oforganizatjon/business: jLi VpJ < iLVa-A > t <br />A-UC <br />( Lsf ) _______ <br />Per* A I <br />I am prowl ng food that« NOT p-epa^ec al home: ^Yes No <br />All food ts prepared on-s4e <x ts from approved commercial fsolifres: 0 Yes No <br />Name of faoKy: Xut. Phone: ( t N*17'3 \ <br />Address of tadity: , <_A M 5 <br />I am provdlng a booth with the toitowng: (to protect my unpackaged food and food-preparaion areas from l>e$. <br />dust and the public) <br />0Other (specify): S\rs\s, <br />Electricity ts provided for my booth’s use: (5J Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Q Yes No