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e , <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> 11 food vendors (bo`.h for pro;t -o5t'. a-e rec -ed to return a sierec and completed copy of this checklist to <br /> the`estiva' co^rdi^ator t r=e(j; .. 3 <br /> �. 1 Na-re of Evens ,�42Z �S� Date;sf <br /> 2. The following is information abot,: crow-..:�aaon,'bus Ness <br /> Nacre cf organization;bus ness: V,4< �'S C"zOe_' 1_!�'- Bd.c�� ,► A� <br /> Address: 2S Pt-tS11AtkA _ - 1-ockt�M Vr► `(��1(� — <br /> phone: 2xvj i _ 5_1W 3Z2 v_ rlte-nate: . 207 317 b , s <br /> L:st`ccd cc sc;d c ..,or t '"a p:;.. SMAU, ce"5+ p*stzkin -- - <br /> 4 1 3m prcvid.ng food t^.at is NOT crecarea at norne. K—ss i `,o <br /> All food rs orepared or s to or is`-om aperwed co•nmeris fa .ie3 ` Yes❑ '`:: <br /> Nam_c°fac: ty _Lia., CownQrc;Cd Phone ;2a�, 3�10 5"3 <br /> F,ddrsss;f facility. r-— —CA% % CM <br /> i U <br /> 5 1 am providing a booth .with the follov.irg ;to pro:__: ri; u-ioackaged food and fooc-p-epa-ation areas from flies <br /> �.Jst and t"e public) <br /> [t A booth with :galls and ceJ!ng cons'U::'aa of er,-ter wood, canvas, plastic, similar material and fine mesh`'y <br /> screen:ng completely enc:osing open food areas. I: -.ill also I-ave a smooth arc cleanable floor (concrefe. <br /> asphalt c':ean tarps and smnc:h %vnod = = acceptable) and const:.icted to sepaate food and rood preparatio-: <br /> areas from;he public. <br /> :rep ;sce_ <br /> Note: The only ope �. :ns rot -equ,.ea to p%:,Jce enci __:: booths ar those whch sell beverages `rom <br /> approved dispe-se-s or prepackaged foods 1-om apt::o:ed sources. <br /> 3 Approved-later for drinking. utensil and nand was�-ing will be provided in my booth cy methods. <br /> Approved oot-ed riater. <br /> Cn-site hose bib that:s connected to a p:;;ab`e,,vatar source <br /> Ot ,er;specify,: _ 'Fo6d jj-UClc IS ecv-i l 1k)A"3p!sWt j_ 04" 1 51 1C 1�r <br /> Electricity is provided for my booth's use- L_ Yes Nod, a, qt,� � <br /> ? I am providing an accurate probe tl-armometer to measure the rot and cold `'oldirg of po:ert.aily haza,ucus <br /> foods du-ing all tines of booth cce-aticn: ;Yes I✓ No <br /> ? 1 am crovi;,na the fol %;ng hot .ter-pe-at..re control for the . of holding of all potentially hSza-d%s foods abo,-e <br /> 13-15'F. <br /> ca� Ste-no S. Hotel,-a:s <br /> stear-er S;ear1 `ab•le& I ds <br /> = r an"c stove t^p Other rspecily; <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1: <br />