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TEMPI .<ARY FOOD VENDOR’S APPLI^, TION <br />11 nEvwt <br />lk’ U'' <br />) .Phone5 i <br />B <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the foltowing method<6, <br />Q Approved bottled water. <br />7. <br />8. <br />a <br />1. ' : <br />Note: The only operations not required to provide enclosed booths are these which sell bevefages t-./r <br />approved dispensers, or prepackaged foods from approved sources. <br />O Stemo & hotel trays <br />Steam table & Mete <br /> Other (specify) <br />FO <br />I am providing an accurate probe f <br />foods during ail times of booth operatton. <br />OCwnpstm <br />O Doubte stew <br />0 Electric stove top <br />tiwmometer to measure the hot and cold holdir^ of potenfeHy imarctoue <br />eratton: E Yes (~1 No <br />t am providing the fotowtng hot temperature control for the hot holding of alt potentially hazardous toofc abow <br />135T: <br />I <br />( J <br />meats, tamalm, .wktd beam, ric*. <br />S -sOiSfc sc ;* >S<¥ ||««■> A- *■' S’;! <br />■ . . <; ; , <br />V: ssA AT > <br />hxx! vpijsThsrs (iM'th Iw profi? a»rd rwn-ivofit) .«:i> rnqtitmd to rchim .> sgned and ■ ompkstwi o .py f>< thi* <br />tor* fpshva' cewrhmrtot threw ( J) wBfAs prw< to tills bv«hM: <br />■ I <br />'■ !S .K'v't'f my ,uu trii.-nilOfdbiir uv '.' <br />;dhvl / /) ! <br />j\cc V c <br />„ in ! <br />■ a ~ - f <br />.Mt <br />tl. <br />| - :: • ' <br />I am provtdtng a txx>th with the following: (to protect my unpackaged food and food-prepamMH’ aro.c:. ;'ou <br />dust arto toe pubito) <br />C A booth with walls and ceiling instructed of either wood, canvas, plastic, similar matenal ■’- t ' ■ = = <br />sehBentog. ramptetely enclosing open food areas. It will also have a smooth at c <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate frxxi and food prev.a' . <br />areas from the public. <br />V j OBw (spedfy): _I.:.. <br />Note: Examples poterrtially hazardous food Inclocte: <br />vegetables, potato salad, eggs, and daily products <br />n- L <br />Q On*site hose bib that is connected to a potable water source. <br />Xj Other (specify): j I GlCl.h <br />Etorfcity is provided for my booth’s use: Q Yes O No <br />FH f /Z OO --3. • ms. food to iv sold or grven to she public, y..JhJZ;. <br />4 ( i.vuw.j.mi ’.Xte that,is HOT prepared at home: Yes ( I No <br />MfoOd is prepared,on-.sit3or is from approved commeicwl 1<st.h.’» ' ■ N' <br />Name of facility, , _____ Phono, i. < <br />Artoross of facihtv .. __ .... ............................ . . <br />4 (u■ 1 L. v u ’X O <br />Alternate: ( j <br />I . !' 1 I ‘if ‘ f i