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IMAGOzdO.JPG 8/26/19, 3:31 PM <br />4. <br />5. <br />6. <br />7. <br />8. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />aboutblank Page 1 of 1 <br />□ Stemo & hotel tra/ <br />H'Steam table & lids <br /> Other (specify) <br />P Camp stove <br />I ^Double steamer <br />\] Electric stove top <br />of potentially hazardous food include: <br />Phone: <br />List food to be sold or given to the public: /j's/j <br />, kl SkZ <br />•po 16-02 <br />’4H5 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />^fSvV^(b0,h profit and non'profit> <br />Note: Examples c. ,---------- . , , <br />vegetables, potato salad, eggs, and dairy products. <br />Electricity is provided for my booth's use: 0res No <br />I am providing an accurate probe thermometerto measure the hot and cold holding of potentially hazardod^ <br />foods during all times of booth operation: □'Ves No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ISST: <br />^coordinator three (3) weeks prio7to tfe 3 completed of this checklist to <br /> faniih jhy Date(s): <br />The following is information about my. organization/business: •5*^// 2. <br />Name of organization/business: /^Z KMt / <br />Address: ZZ . ______ <br />( 3^5/Alternate: ( % <br />I am providing food that is NOT prepared at home: 0Ves □ No faw.S <br />All food is prepared on-site or is from approved commercial facilities: Q^fes <br />?ame of facili‘y: _____________Phone: (9^) <br />Vidress of facility J1 Ob V>ld3 C A-,________________ <br />1 ^dusTandth9 & ^Ijh foll°Win9: (t0 protect my unPackaged food and food-preparation areas from flie^' <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />Y eening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />phalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />EJ Other (specify): p xZ- j-tX—-y' <br />^te: 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 method^ <br />PfApproved bottled water. <br />N Other (specify):