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TEMPORARY FOOD VENDOR’S APPLICATION <br />■" are of Event:□a": s ; <br />Phene: <br />List ‘etz :z ,:z zz'.i z: zv;^' vz ‘t’c pi± z. <br />P: ::'ig £ <br />5 <br />j Other ’soec:?'/): <br />3 <br />■ i Cii-si;e hese oib that s conneotec to a potab e ;vater source <br />1 Otr-er (speejyt <br />zlect'ioity is prevideo for my bcoth's use’ VfI <br />3 I am p-ovitimg an accurate probe thermometer to measure the ~ct and cold ‘■cldirg o' poterttaiiy haza'deus <br />•'oocs ciu-hg ail times of booth cpe'atic'i: __ Yes CZ No <br />? <br />Page 7 TE’.^ "VZf." A <br />6 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Aporoved .•.aferfor drheng utens.i and na-d r.asmr.g tvi: be provided in my boom z, t~e milovri-’g metnoos <br />_1 Approved bottied water. <br />Note: The- or.iy operations not •’equ.red to pmvie'e enclosed booths a'e those wh en sell bevc'ages Yom <br />approved dispense's o- p'eoackagec' foods £"om approved sources <br /> <br />i am providing a booth with 'he fo’lowirg ho protect my unpackaged food and foou p-epa-ation areas Tom flies <br />d.,s: and the public) <br />B'Stemo S. -otel t's.s <br />f~i Steam table 2. i ds <br />_J Other 'spec <br />~i Camp stove <br />L Douce steamer <br />ZZ E er," o. stove top <br />I am providing the following ho* tempe-atme control for the ~ot hold -p p- an potentia'lv haze'deus foods abc.-e <br />135T. <br />Zes [*J No <br />S?A booth with .vails and ce "g co"st'jt:tea of either wood, canvas, plastic, simi ar mater a. and : re mesh ■ y <br />screening completely ermos.ng open food amsas. It will also have a smooth arc cleanable ’loor foortorete. <br />asphalt clean tarps and smooth wood Sre acceptable) sne constructed to sepamte food and food p-epa-atran <br />areas from the pubic. <br />Address: _ <br />62942— <br />3krxnLn_y.^Ja <br />I am prevd ng food foat's NOT •mcca'ec st "ome Lj No <br />All food s oreparetfoan s te or is from approved comwercial<faci' ties C! Yes [ <br />Name of foe iy L I <br />Addfass of facility: <br />All food vendors (both for proffi and non-profit) are required to return a signed and completed copy of this checktist t? <br />•h= 'estiva' oo-'di-.ator tt-reYfS' .-.pe-'s imiy-v th s ev-nt zx ZhK.b fook oft2 <br />I he f~: owing is info-mation about mv.ccom-cation.bum-ess <br />Name c‘ o-genizat'enfotts ness: <br />meats, tamales, cooked beans, rice,