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6/7#03-07-19;04:29PM; <br />-toif <br />1.__Date(B): <br />2. <br />3. <br />4. <br />5. <br />e. <br />7. <br />8. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APP <br />END 164)2 <br />UqooL a ^sc<- a_ji- f 5~ir <br />trie festival coordinator three (3) weeks prior to this event <br />Name of Event; <br />a signed and complelad copy of this checklist to <br />O Cemp stove SleTstemo & hotel trays <br />^Bouhle steamer /Z\@-Sleam table & lids <br />Ll Electric stove top /^D Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy produces. <br />^3; Zo <br />( to H <br />0/ -? ta 2 . lot *} <br />Ha- ““ “■ “""i“ •- <br />Approved water for drinking, ulensll and hand washing will be provided In my booth by die following methods; <br /> Approved bottled water. <br /> On-elte hose bib that Is connected to a potable water source, <br /> Other (specify): <br />Electricity Is provided for my booth’s use: Yes £S3Mo <br />fn 8eail^^robe lhf,rm^;eter to measure the hot and cold holding of potentially hazardous foods during ell times of booth operation: QjTesn No y n^wus <br />l| am providing the following hot temperature control tor the hot holding of all potentially hazardous foods ebove <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendore^(both for profit and non-profit) ere required to return <br />The following Is Information about my oraanlzatlon/buslness: <br />Name of organjjation/business: \ J^cL'f' 1-CnS <br />Address: fOW- tSoX 2-^ <br />Phone: (£rfi?7 ^0 Alternate ( <br />List food to be sold or given to the public; <br />I am providing food that Is NQT prepared at home:4^.Yes Efcftfo <br />Al food Is prepared on-jlte or la from approvedcommercialfedllHesi'^Yes No <br />Name of facility; /Vhanar^tff “7^7 <br /> Address of facility:.iS o La <br />duS Se pub£Oth “’a foll°*in9; <'° prat0Ct my ^packaged food and food-preparation areas from flies. <br />° 1°0l,llnB const2'cted of sither wood, canvas, plastic, similar materiel and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />areasfromfoejibnc0 ’"’‘’“b WOOd Br6 ■“8pteble) Bnd “^^ed to separete food and food proparetlori <br />□ Other (specify): ffi. / /