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TEMPORARY FOOD VENDOR'S APPLICATION <br /> 'U'l food vendors (bO*h 1c <br /> j,j <br /> • \a-e's,Event C, <br /> 2;q <br /> _-h-e fog )Being is irforrnat,zin lt::ait my cnqar-_-116*L;­, tat <br /> iV <br /> Address- c�! <br /> Phone-. <br /> *o "c ScIr4 put <br /> am prcv,dirig food tt-,qt Is LOT precarea zt -Q,.,-ie 1 i Yes ❑ No <br /> Alf food is Drepared on-site or is from approved co-n. merval fa^i­ies. Yes❑No <br /> Name cIr facjl:ty, Phone <br /> Address of mFaCjjj,,V: <br /> I am providing a booth with the follovring (to protezt my unnackaged Foci and food p-epa-a!ion B(;�s lfsm <br /> C!-js,l and the public) <br /> A bco.11 %vith %vails and cei:inzj cors­uuted of either wood canvas. plastic- swqi'ar mater-al and I r e mr- h <br /> screc-n:.n;; comple,,ely enclosing open food arpas it will 9!%o have a smovh and cle2na3t= ;Ioo, (7mnarste <br /> asphalt, Clean tarps and smooch wood are acceptable) and co'lStrurted to sspwaze food and"Cod n7epa'allon <br /> areas from the public. <br /> 17 0ifier(scecIfy'). <br /> Note: The orAy operations not required to provide enclosed booths are tll3se which sell bei;_rao-es '-om <br /> approved dispersers. o-prepackaged foods from aporoved sources <br /> Ap:;rove-d water for drinking, utensil ard nand washing wil,'be provided in my booth oy the*Zlloynnn rrethozs_ <br /> T Approved nottled water <br /> k'j On-sll.e nose nib that ;s connected to a w),,ab'aviater source <br /> I O,her(spec.fy)� <br /> 7 Electricity is provided(or my booth's use• i Yes El No <br /> 8 1 am providing ar, ar-curale probe thermometer to measure the not and cold holdirg of PzIant,34Y I)3z3"_0,Is <br /> `Cods dL7iJIIg all-,­nes of booth operation: IIE, Yes F No <br /> 9 1 ;-zm pro%dt,nq the foftrhing hot ,emperatve control for the ;not hn!d.-g cf all pcitentia'.ly 117-73rd:!US*M dS at:Ja <br /> 1 5*F <br /> a—,,r, stove L7 S-,e-no & hotel, <br /> �JL Other (sPecif I <br /> E;ectris stove too y <br /> Note: ExarnIp-les of potentisily hazardous food include: meats, tamales, Q00ki2d beans. rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 7 T-_ <br />