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TEMPORARY FOOD VENDOR’S APPLICATION <br />' z-‘ E'/e-’t: <br />Address: <br />Pnene: <br />3 List toed to sc sold or given to the pub v <br />z <br />Phone <br />_-r <br />5 Aps'cvsd >'.a‘.grfbr d'in-;.ng utens.l and nand '.•.as-irg ■.•/T ba provided in ry booth cy tne 'oilowing methods <br />App-cved oottied r.-ater <br />: i On-si‘,e hose bib that s oonneotea to a potabe .nater source <br />~i Ot:’e' {spec-fy; <br />=iec? n.ty is provided for my booth s use' ETYes F- No <br />3 <br />? <br />u is-.:?"'□7,“ 7 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: Tne or'y operations rot 'equ.'ed to p'ovic'c enclosed booths are those 7-.'h cn sell bevo'ages f'om <br />approved cisoerse's c- prepackaged foods f'om approved sources <br />v<s:ctio i -otei t'a.s <br />Q Steam table S. I ds <br />Jj Other \ipec-y : <br />mC( WW. <br />■ I Other |scec:fy>: <br /> <br />i am providing a booth with the following ::o protect my unpackaged food and food preparation areas from flies <br />dus: and me public) <br />'~1 Camp stove <br />L Dour; e steamer <br />ZZ - smr o stove top <br />urT-. booth with walls and ce ing const usteo of either wood canvas, plastic, simi ar mater a arc : ne mesh *y <br />screening completely enclosing open food areas. I: wili also nave a smooth ana cfeanable floor (cor ;rete <br />asphalt clean tarps and smooth wood ar- accepts!:!e) anc oonst'ucteo to sepamte food and food p'epa'abon <br />areas from toe pubic. <br />I am p-oviding an accurate D'Obe thermometer to measure tne rot and cold I'clcirg o‘ potenbaky tiazamcus <br />foods ou-ing all times of booth cpe’aticn. Yes No <br />: am prcu.ding food ('■at's NOT r;rc-oa'ec st -on? vfYes C No <br />All food is prepared or ile or is from aprfoci ue?. <br />Name o' fac :y <br />Address of faollitytj <br />meats, tamales, cooked beans, nee, <br />The fol owing is information about mworg|n:zation;business: <— <br />Name cf o cani-jt on b..s ness: <br />W5 <br />Ail food vendors (both for profit and ■'on-orcfiL a-e recuired to return a signed and completed copy y tws checklist tn <br />- - “ 1MT ' fek QU ... iSU <br />I am movithng the fol ov/ng hot tem.oe'at.:'e oortrcl Am the -pt noid 'g r- ail potentia'N hazardous foods abc .■- <br />135;F.