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1 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 \3T3of Even:: <br />2. <br />:3 <br />5 <br />5 <br />Z <br />3. <br />9 <br />T7',?o £Vgb’ A*1 <br /> <br />Fo?*-’ ^11 <br />Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products <br />O Caw stovs <br />C Coub-s stear-er <br /> Electric stove tap <br />2 Other (specify);■ . . <br />Electricity is provided far my booth's use: l^Yes p Mo <br />I am providing an accurate probe tfcermomejgr to measure the rot and cold hoidirg of poSenUaKy hazardous <br />feeds •during all times Si oooch cperalion: Yes C No <br />. I am providing the following hot tempe-ature cortrol 'or the hot molding cf all potentially hazardous foods .above <br />135'F. <br />All food vendors (both for profit and non-profit) are requrerj io -eatrn <br />the ‘estiva! coordinator three (3.) weeks prior to this even* _ <br />j.io tec? <br />'h.wir <br />Q Sterno a hotel trays <br />O Steam table i lids <br />p£cw •sped-.*/! "t <br />meats, tamales, cooked beans, rice. <br />a signed and completed copy of this ch^^list <br />LuVhst Deietp; <3^ <br />The fallowing is information about my organizaten/business: <br />Name ct crgamzadon.'trjs ness' __________________________________ <br />Adcrass: 3017 5S355T.— <br />Phene: ; TjO? _52Z1?.'-6'Z/ZV-Alternate: ■ ----------- <br />List food to ze sdd or given to ‘he pub ic C>OK Io*lf f 16^,/XMVqS <br />x-SduZw- r* »<51 Uuer4 J <br />1 snrpreviding food that •s NOT prepared st horns: T as • J No <br />All food is one pared on -site or is from approved commeroia: faci’-tiest ^fYes C No A" Y" <br />Name cf fac-lify;Pixme- L~._.d__________— <br />Addrass o.t facility: __________ ________________________——------- <br />I am providing a booth with the Mewirg ftp protect my unpaokagad food and foou-p eparstion areas from fiiee <br />dust and rhe pubic) <br />[T a tooth with walls and cedng cons’/uotsc o' either '-vood. canvas, plastic, simifar matw.ai end (me mesn fly <br />screening, completely enclosing open food areas. It .vi# also haw a smooth and cteanable floor (concrete, <br />asphalt, clean tarps end smoefh wood are acceptable) and constructed to separate food and faod preparation <br />areas from the public. <br />O other ■specify): Feed -KcGVev <br />Note; The oniy operations rot required to provide enclosed booths are those which sell beverages Yom <br />approved dispersers or prepackaged foods from approved sources <br />App’Oved water for drinking utensil and hand washing w*fi be provided in my booth cy the follow,ng methods. <br />5f Approved botifad waiter <br />fl On-site 'hose bib that is connected to a potable-water source,