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TEMPO"RY FOOD VENDOR'S APPLICATION <br /> All loud vendors(both for profit and nonprofit)are(equtred to return a signed ago comptetod copy of this&MCOO to <br /> lftie lesirval coorrhata NN �{3)weeks prgr to this nt <br /> m C�r <br /> � 1.Name Of ENlhflt. <br /> yg�e <br /> 1 1V i 1 r Dates) <br /> The fbtlovIvig*information aboLgn orgenizewubuSness <br /> Name of orWaab=bUsafress ` p <br /> Address- � ) 'lJ Y "' <br /> Pho,e (?)L7 ) O Aftemate { ► f I ! <br /> 3 Lot food to be sold a b pubic�, VIN <br /> � )J `BUJf"1 Dl{7f GsIrrl/(`i � ,1 h CY J <br /> 4. I ern Providing food that Is M"md at Yes❑NoAli Id w— Yes <br /> C' <br /> o � �� OPN <br /> Address C, <br /> 5 I am p[owding a booth with the following (to prptetl n7 unpac"ged ford and tood-preparation areas front flies, <br /> dust and the PUNK) <br /> E]A booth with walls and Sailing comtructed of either rood.canvas.Plastic,snit3r material and fine mesh fiy <br /> screening.0ompleta3y urxlostng open food areas. It writ{otso have a smooth and Ueanable goer(concrete, <br /> asphalt,clean larps and smooth wood ere acceptable)and mnstnrded to separate food ` \ <br /> s <br /> areas kon the pugc p c. 0 �I 1 <br /> Other(specify) 1 A)b " IcyJ�jK f <br /> Noes: The only opera nrlosad operations not required to provide e booths are Mom which sell be�s from <br /> eppfa,ted dispensers,OF prepackaged foods from approved sources <br /> 8. Approved water for dunking,utensil and hand washing VAU be prmndecl m my booth by the follow fTg mrthats <br /> ❑Approved bottled water <br /> ❑On-ado hose bb that 5 WrYrecled to Dotal la wafer Spurts <br /> lw�clb: <br /> ,,117 a ptowded for my booth's uses ICI Yes❑Nc <br /> B. I arts providing an accurate probe themrortMt!` er to measure the hot and cold holding of Potentially twarOous <br /> foods during all Urnes of booth operation vea❑No <br /> U 1 am paNdttng the fallow"hot 6arrhperatwe Control for the hot holding of all potenthaily hazardous foods above <br /> 135'F- <br /> ❑,!!!(gy� p atowe ❑Steno 5 trolat trays <br /> / swamer teartt table d tlds <br /> 0 Ekcbx It ..top ❑Other(spec ty) <br /> Noq: Examples of pocentlalty hazardous food include. neap, ttunaln, cooked Dane, ncs, <br /> vegetables,"to salad,eggs.and dairy products. <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />