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TEMPC ARY FOOD VENDOR'S APPL( .TION � <br /> �!I food vendors (both fcr p-ofit and non-crcfit are required to return a signed and completed copy c "113 checklist <br /> the`estival coordinator t r ;',;e '.s p'ior this n`.. to, <br /> / 1 <br /> a re Of CVent: Ll 1 Dat" 201$ <br /> `he foHovring is information about my orgarzalicn;ausi. s� <br /> I�ali'ic � ��'CaniZ?i�on;'bU�'ne�S: <br /> �o <br /> A'dress: O� 7 _Ave-.___ <br /> ., L,... .�_., Le sold or gi'ian �J t~e ✓� LJI II. �endev'S re to 1� 5' <br /> F'" <br /> l am providing food that is NOT creca,ed at home.:.Yes ❑ No <br /> All food is prepared <br /> crr gr is `'c r =t '1r commercial fac':ies '-t 1'es 'ti 2'7 ✓ � � <br /> Naze cf facility: C—� � V2— ,ngone !Sto_r _ <br /> „0 , .S_ of`a�ili, <br /> :_S12 $�tn Pa /a Oe. 49 >30'4j �"nd 4A <br /> I am pro4 ding a booth wvith the:c"owing: (to protect my unpackaged food and food-preparation areas from fie._ <br /> -last and the public) <br /> booth with v.,alls and ceiling c_. _` poled of eit`,_r wood, canvas, plastic, similar material and fine mesh fly <br /> screen:ng, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> .asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Other.;specify!: <br /> Note: 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 was`;ng w^gill be provided in my booth by the=ollowing methods: <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potab'e„✓ater source <br /> =I 0 t In er peciryi_ <br /> Electricity is provided for my booth's use:,I Yes ❑ No <br /> I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> .cods during all times of booth operation:X. Yes C f10 <br /> ?. 1 am Providing the fol'ov,ing hct temperature control for the :ot holding of all potentially hazardous foods above <br /> 1315`T. <br /> _j Ca ,a stove MStemo & ho?eI trays <br /> L Dc..._ e steamer ❑ Stearn `.able& I:ds <br /> c ectric stove top Other(s ec" <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> Pa3e 7 r`,1 TEE'I _t <br /> -'ic <br />