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1._ Date(8): <br />2. <br />3. <br />4. <br />5. <br />( <br />those which sell beverages from <br />6. <br />7. <br />a. <br />9. <br />meats, tamales, cooked beans, rice, <br />p»o» 7 orii TEMP EVENT APP <br />/f <br />EHD 1M2 oaroi/is <br />135T: <br /> Camp stove Q, sterno & hotel trays <br />JSTfrouble steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />=zr10 8 ,i8"’i 8n!i “”pie“ ™to <br />1. Name of Event:, PvH /t&AJ______ <br />The following Is information about my organizatlorVbusiness: <br />Name of organizatlonfousmess: <br />Addrees: ——Ik Q bZXTftisro <br />Phone: §\Q/{ S V <br />Ust food to be sold or given to the public: <br />I am providing food that Is NOT prepared st home:<^Yes No <br />AH food is prepared on-site or is from approved commercial facilities: 0Yes No <br />Name of facility: ________ phone. ( } <br />Address of fecfittv: _______ <br />' 8(fa«rand Uro public)1 foI10Win9: (t0 protect unPaota'9ed foQd and food-preparation areas from flies, <br /> A booth with walls and ceIBng constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It wfd also have a smooth and cteanable floor (concrete <br />a^» fromtoe pubfland Sn,OOth W00d are accePtabte) 8nd constructed to separate food and food preparation <br />□ Other (specify): t.S, <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing wiB be provided in my booth by the folfowing methods: <br />^.Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): _______________________ ___________ <br />Electricity is provided for my booth's use: O Yes Q^-No <br />1 •-'>-««*■ «*• <br />1 (BSVid,n9 the fo,low’n9 hot temperature control for the hot holding of all potentially hazardous foods above