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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All trod venoDi S lb oM for profs and norHxDttt5 are regu+red to return a sig iW and compWod copy of th4 checklist to <br /> the festival voardutator twee(3) weeks prior to thra event <br /> 1 t Noma of Event,_ `�kT%C Date() <br /> 2 Thar'fallowing o rnfurmaborl about my argan"biontLoiness <br /> Name of organlz8/roc nnibusin fess:_ fL)P A)A SkA L . 011;P', <br /> Adaress <br /> Phorw i IL% y LCA;la 3 Aftemate <br /> 3 Lal food to be sold or given to the public J►rrl++i —or.-yr-7, ZeAriict L+r-i •�s' �Ot?I <br /> A. i ani providing food thK is dQj pre owm at hOttte- !d❑ No <br /> AN food is prepared on-srte or is from approved comnWWCfol faOMM Q Yes❑No <br /> Name of tawy _--Pn01W <br /> Address of facafrty <br /> 5. 1 am provlcb-ng a booth wi*1 the foliewng (to prt0bod my unpackaged food and food-nn"rabon areas from flies, <br /> durst and the pubic} <br /> W A booth wefh wall$ and m4ng constructed of either wood, canvas, p!astlo, similar material slid line mesh fly <br /> 9rreening, compietety endosmg open food areas tt wnll also have a wr'booO and deahabile Mw (eorwete, <br /> asphalt, dean tam and smooth wood we *cCkVat*) and cortsfructed to separate flood and food omparat4n <br /> areas from the pubic <br /> Nobe: The only opefabons not requlre+d to provide enclosed traaths are thase 1r hw-h sell bev ragas from <br /> approved dispensers,or prepackagsd foods tum approved sources. <br /> 6. Approved water for drw*mg, ulemid and henna washing will be pmvsded in my booth by the following me!hods <br /> Approved bot:Wd walar <br /> ❑ Orlt-sft hose orb that is connrcted to s putata+e waler source <br /> ❑ Cltiter(Specify): w.__. �x,..-_.... ._... . ._. .._�._ <br /> 7 E;ectridty is provided for my booth's use Yes❑No C1 L"Ikd 6rx"r'.Vpf)F ' tiz. <br /> d, 1 am providing an accurate prober thermometer to msastoa the hot and colo holding of pf Uwdi$lfy hazardoua <br /> foods dump all timer:of booth operabon. 9Yea C No <br /> 9. 1 am pervading the fbkwing hOt Semperature cornroi fear the hot homing of all potentially hazardous Was above <br /> 135'F <br /> ❑ camp clove ❑ Sterno&hote3 trays f <br /> ❑ Double Stearnef ❑ Steam table&lids 1�.frf 04 <br /> ❑ Electric Stave!top ❑ Otherr(Spe vtyl <br /> Note- Examples of pobofldally hazardous food Include. masts, tamales, coo$tad beards, nce, <br /> veget&W**, pcteto sakW,eggs,end daWy products. <br /> Eft�." •-lags r to 1LO.W LvL'J-.�F� <br /> W".•15 <br />