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temporal <br />1. <br />2. <br />Address: <br />Phone: <br /> <br />3. <br />4. <br />5. <br />6. <br />D Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br /> Camp stove <br />0 Double steamer <br />O Electric stove top <br />O Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Sterno & hotel trays <br />0 Steam table & lids <br /> Other (specify) <br /> Other (specify): _____---------------------------------—--------- - <br />only operations not required to provide enclosed <br />Bi-D 1M2 <br />VJ4/15 <br />dc>O <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />9 x .x(C z k / A _ L1.L_1. Name of Event: _±xlJI|2£}_t_3=£Xj3—i—------ <br />The following is information about my organization/business: <br /> <br />Name of organization/business: <br />,:OOD VENDOR S APPLICATIC <br />a signed and comfWd ™Py of this *eddi«l io <br /> Date(s): <br />Name of facility: (_ Er ------ - --------- - -------------- <br />Address of facility: 'J( fl Mt? (in----u—A-------> <br />I am providing a booth with the following: (to protect my unpackaged food <br />dust and the public) <br />□ A booth with walls and celling constructed of either «°0^“™as. aeaennable"«oo?e(<Z^etey <br />1“ aSaMe) and constructed to separate food and food preparation <br />areas from the public. <br />Electricity is provided for my booth's use: YesMNo <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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br />Phone: ( J------—------------------------ <br />fA — <br />and food-preparation areas from flies, <br />'VSZ. <br />Lfst food to be sold or given to the public: upY. ~~ <br />I am providing food that is NOT prepared at home. 0 YesjZJ'No <br />All food is prepared on-site or is from approved commercial facilities.^ Ye>^Wo <br />Name of facility: i_ pfo <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <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 /> ----------- <br />