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No. 2854 P. 26Mar. 4. 20 1 6 1 2:58 PM GHIRARDELLI <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />PagaZoHl TEMP EVENT APP <br />4. 2016 12:50PM No. 0539 <br />EH016-02 <br />11/4H4 <br />are those which sell beverages from <br />Received Time Mar. <br />Date(s): ^^4 <br />I am providirig food that is MOJ prepared at home: ^Yes No <br />All food is prepared on-ste or is from approved commercial facilities: S^Yes R No <br />Name of facility: - Phon®' {X <br />Address of facility: ...... <br />TEMPORARY FOOD VENDOR’S APPUCATON <br />X SSSK,0 a stened ’"d “mp,e,ed wWs ote:W““> <br />1. 1. Name of Event: (?k * U <br />The following is Information about my organization/business: <br />Name of organizatiorVbuBiness: <br />Address: /Zt^~ g-«h/^ <br /> <br />Alternate: ( <br />List food to be sold or given to the public: L <br />■ 1HU’efcll0'’i"9: <to proletl •W xnpassased food and fcod.pre.DarallOT frzn ff.ns, <br />™ ” aCCSP“te) and 00"™‘!“,0 sepan‘ta« W«X <br />D Other (specify);______ _ <br />Note; The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />O Approved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br />. Other (specify);_ <br />Sectricity is provided for my booth's use: Yes No <br />' w a"d “,d ~ “ <br />I amjwvidlng ta J**, «lempe,ahlre OTtro| for ltle M <br /> Camp stove Q sterno & hotel trays <br /> Double steamer QJ steam table & (Ids <br />‘- -D Electric stove top Other (specify) <br />Noto; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.