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TEMPORARY FOOD VENDOR’S APPLJCATON <br />1.1 Name of Event: <br />2. <br />Address:1 <br />(4c% S -22^02-Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />31 2 <br />5. <br /> Other (specify): <br />6. <br /> Other (specify): <br />7.Electricity is provided for my booth’s use:No <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APPEHD 16-02 <br />7/14/16 <br />I am providing an accurate probe thermon <br />foods during all times of booth operation:; <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />iter to measure the hot and cold holding of potentially hazardous <br />2 Yes No <br />___________ Alternate: ) <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />pnnrO'/QH rliqncmccirc' ■Frrirn cniirnacC-4 f-Z f-< I V XU lOkxl O| </l f^l I I <7 I I i W f-Z I V - <4 JVUI <br />Phone: (AoS) £T* £— <br />CA <br />I -) b <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />^LCamp stove <br /> Double steamer <br /> Electric stove top <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Tanlale. fGsnvAl DatetskacAr iG -/i <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />2Ya booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />^screening, completely enclosing open food areas. It will also have a smooth and cleanable 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 />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: EZfYes No <br />Name of facility: LlaCu <> fci cfch (\ A <br />Address of facility: 31^ i L2p <br />The following is information about my organization/business: <br />Name of organization/business: luckys <br />i rie Dr