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t <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Address: <br />Phone: <br />3 <br />4. <br />5. <br /> Other {specify): <br />5. <br />3 Other (specify): <br />Yes No <br />s <br />9 <br />meats, tamales, cooked beans, rice. <br />Pajs" of 11 tsmp av=M 4 - = <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: The only operations not required to provide enclosed booths are those whfch sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Q Sterno & hotel trays <br />‘Sfsteem table & fids <br />S Other (specrfy) -j-d <br />SHO 16'22 <br />t-j.xfi* <br />Qfl-5iVet _______________________ <br />I am providing a booth with the fofiowing: (to protect my unpeckaged food and food-prepareiion areas from flies, <br />dust end the public} <br />Approved water for drinking, utensil and hand washing wifi be provided in my booth by the following methods: <br />^Approved bottled water. <br />O Cn-site hose bib that is connected to a potabie water source <br />t3 Camp slove <br />‘^Doubie steamer <br />O Electric stove top <br />OLA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fry <br />greening, completely enclosing open food areas. It wi8 also have a smooth ana cdeanabie 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 />'Er to messure tire hot and goIg holcinQ of potentially hazardous <br />iYesCNo <br />Electricity is provided for my booth's <br />I am providing an accurate probe ^ermomel- <br />foods during al! times of booth operatfon.*® <br />I an providing the foKowing hot temperature control for the hot rioHing of all potentially hazardous foods above <br />135’F: <br />All food vendors (both for profit and non-profit) a-e required to return a signed and completed copy of this checklist to <br />the ’estival coordhator three (3) weeks prior to this event. / / <br />1. Name of EvsntS / patets > 3 / <br />f 1P^8T' <br />The folowi-ng is information acout my organizafcnfousiness: [ V' 1 1 1 <br />Name cf orggntzatiOT/b'Jsiness’ 'Ocfo 6coS VvCoS________________________ <br />UO5 La). CV __ <br />( ^p’a-) foOLp- ________ Alternste: f ) ________________________ <br />List food fo be sold or given to the public: ^Qi_ig,$cklV<S/ <br />1 an providing food that is NOT prepared at hrxne: O YesT^No <br />AS food is prepared on-site or is from approved commeroia! facilities: Yes No <br />Name of factEy. Phone { } <br />Address of facility:.