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S A N 10 A U I N Envir«nmental Health Department <br /> . .'a�r,e.'. t..s rf(1[r.'SS �r01ti: 7l r•i i' .. - ;�C'' ; -.. -'Y�� <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All faad vrtndors (bath far pro and non vroHt) are rr,ctQired tp rrturf'� a sjclned @ciel (,ur)plPteci copy of ihss ctteckllst to <br /> the festival coordinator three (3)weeks prior to this event. <br /> v� t 2 2 a 2 <br /> - I <br /> 2. The foltowi%is inforrr►ati00 ObOut my Qrgot1i2,sltr,tisd,,+ssriess: <br /> Nznie of arracaeAratior7lbuslttes5: � -A_ .. os <br /> .. - . <br /> Address: <br /> Phone: l (0 r - ( ( Alternate: (2,p4l )�1 (o <br /> 3. I Est tends; e sold-Or given to the public: G(L�J (y2 tX5 Cic aSc_& -ri e [1 L/fr . <br /> 4. t am providing food that is NOT prepared at home. t� Yes ❑ No <br /> All food is prepared on-site or is from approved coWiercial facilities- 1� Yes[} No <br /> Name of facrlity v k o C1 +r Phone: " S <br /> Address of Facility e' - 1�- ✓ `� D r` +� n C. Z <br /> t and ppmAding a booth with the following: ito protect my unpackaged food and food-preparation areas from flies_ <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic,, strnilar matenat and.fine mesh,fty <br /> screening, completely enclosing open food areas. I# will also have a smuott, and cteanat)le floor (corcreW, ' <br /> asphaft, clears tarps and smooth wood are acceptable) and cr'f :;tfucted to separate faad and food preparabor>t <br /> areas from the public. qq <br /> CAher(spe cIfy): >✓[ !� <br /> Note: The only operations not required to provide enclosers booths are those which sell be <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved wateor for drinking, utensil and hand washing wlli be provided in my booth by the.fofiiovvi x0,�: ' <br /> [�Approved bottled water. <br /> ❑On-side hose bib that is connected to a putabie water source, r�. r <br /> ..erg .•: :, <br /> 7. aectricity is nroviderl for'my t};c,tl,'s usr Yes No <br /> R. I am providii,g ar. accurate probe ihermotmeter to measure the hot and cold tro <br /> a +� <br /> foods dtjri rj all turves of bor,rr, operation: �A Yes ❑ No - ,lt; •�`� t <br /> hrcrvlr.1 r,c. trey ?rjllrnwEnt� i L+ temperature Control for the hot ho)ding of all pr016rttl <br /> rJ Catrsp :-mvr,• Slamo & hotel trays ":.w-, +"�$r " , �• <br /> ❑Doutble steamer , Steam table & lids <br /> E�F eCtn c e lop ❑ Other {specify) <br /> t 5#ciu <br /> Note: Exanipies of potentially hazardous food Include: meats, tamales, cooked beams, rice, <br /> vegetables. potato salad, eggs, and dairy products. <br /> 71 <br /> F .j{Y 4 J-01,3 ', <br />