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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All haMl vancl++lp(bosh tot prolil milli rust („1,111)ala ralltrinad to rplmo n vlpnnd and complolod copy of this chockllst to <br /> III"laalival 1voolt11ltalot IMaa(;i)wlaaka pilot (n Isis+pvanl <br /> 6/17, <br /> I Ito tollowptu It*k,torntalkun alunrl my orpanUallonlintnlnaas; <br /> Nanta of oruanitallonll,truUtapp AWV801110 134TO-W <br /> AddrMaa 4,21111 [laintivold Avg) <br /> Photo (41Ill )00 -V G - _... . , ._-.. __..0 Alternate: (4 15 ) 416-0626 <br /> ,1 l lot toot)to t►a Tkold 01 pivan to tlna public; .-AymVmg..@mr.;;{a urawla snack <br /> 4 1 am provldinp toot!that is t=proparotl at hams: [)Q Yam E7 No <br /> All total in prhilara ll on Sita or la h mt npptotiod commorelal faciNlios: [A Yes❑No <br /> Nama tit faclilly UnIng!til-LLC. Phone:( 1 <br /> Addnaaan of facillly 425 Attrnovold Avo, San Francisco, CA 94124 _ <br /> Is 1 till,providinp a tooth will)the following: (Io protect my unpackaged food and food-preparation areas from(lies. <br /> dur+t and tho public) <br /> []A boot)with walla and calling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> ncrooning, completely enclosing open food areas, It will also have a smooth and cleanable floor (concrete, <br /> naphalt, clown larpo and smooth wood fire acceptable)and constructed to separate food and food preparation <br /> araas front Iho publk,, <br /> [A Omer(specify): I a_ m selling a pre-packaggd to d from an approved source. <br /> Nota: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved disimnsers,or prepackaged foods from approved sources. <br /> s. 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 /> ®Other(specify): hand washing station <br /> 7. Electricity Is provided for my booth's use:❑Yes®No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> ! foods during all limes of booth operation:❑Yes❑No N/A <br /> i <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135"F: <br /> ❑camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> 0 Electric slovo top ®Other(specify) N/A <br /> Nota: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vagotables,potato salad,eggs,and dairy products. <br /> LNUInW I+ plofII 1LIW'LVt.NIWV <br /> WoI,to <br />