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#4/703-07-19;04:29PM; <br /><• <br />i. <br />2. <br />Phone: <br />3. <br />S. <br />6. <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice, <br />p*e»7M ii TEMP EVE HT APP <br />EMi taco <br />am those which sell beverages from <br />[~OLfp <br />.(/(/> S OLi \jp <br />Ust food to be sold or given to the public;____| <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) am mgulred to return <br />the festival coordinator three (3) weeks prior to this event <br />Name of Event <br /> Stemo & hotel trays <br />ETsteam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />Ej OrpsJts hose bib that la connected lo a potable water source, <br /> Other (specify): _________________ <br />Electricity la provided for my booth's use: [0^es No <br />hazardous <br />< ??.1?ro*i<,ino lhe foio*infl temperature control for the hot holding of all potentially hazardous foods above <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />b signed and comptetod copy of this checklist to <br />. . /-f-n . <br />10^6 DhM pgb,AV <br />The following is Information about my organizatiorVbusinesB; -Gy ^8-/201^ <br />Name of organization/businesK ^~0L 7c~) NX H \ > I______________________________ <br />Address: J | (/> S /OLi \JP ZW r S4tQ f /I r(A p____________ <br />---------------Alternate: (^Jty) V (ip <br />C£\ M cl <br />I am providing food that Is NOT prepared at home; ffl Yes No <br />All food la prepared on-site or Is from approved commercial facilities: H Yes No <br />^eoffodllty: 7^ ( D _____________Phone: (24^ O ! <br />of facility:—I/y A-V. S4-<?cTfr>b <br />riuM tha foltowin9: <to Pro,ecl my ^npackaged food and food-preparation aroas from files, <br />vUBI kBHj u)O pUDilCJ <br />COnst^clod 01 wood- canvas, plastic, similar material and fine mesh fly screedng completely enclosing open food aroaa. It will also have a smooth and cleanable floor (concrete <br />Sn’00°1 '*00d art> acceptab,o> and CCT”frua« » separate food end food prepac8tlo<; <br /> Other (specify); <br />Note: The only operations not required to provide enclosed booths <br />approved dlspmsera, or prepackaged foods from approved sources. <br />Approved water for drinWng. utensil end hand washing wdl be provided in my booth by the following methods: <br />[^Approved bottled water.