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1BARPORARY FOOD 'VEND OR'S APPUpan' TOIN <br /> Ail R)od vendus (both for pmfit and non-pf*,1 are reqiji-ed to return a sowd ark mylpieted copy of t* ch fis! to <br /> the 11--stiv21 cooMinator three(3)weeks p6or'to this event.I I I 111,-,)-) F-,IX t vl- Daw(s) 7, -/7/ -9 J <br /> 1 1.Nafne of Event Ell ��- L L, ��A. j <br /> 2 TP&fallowing is information about my organization Az)usinessl- <br /> Z-A) <br /> -'2 . 'I , <br /> !Varna of organvationn�-usiiness: " '),6� A <br /> Address: u L <br /> Phone: Aftemate, <br /> 77 <br /> 3 -> 1, <br /> List food to be sold or given to the public. -- / — <br /> 4. am providing food Mat is NOT prepared at home: {Yes [�' No <br /> All rood is prepared of,,-site or is from approved commercial facilities Z-Yes ❑ No <br /> Name of facility Phone: <br /> Address of facility_ <br /> 5 am providing a booth with the follovkning: (to protect my unpackag-ad food anc,food-preparation areas from flies. <br /> oust <br /> and the public? <br /> Q�A booth with walls and ceiling constructed of either wood. canvas, Plastic. similar rriaterial anti fine mesh fly <br /> ning, completely enclosing open food areas It will also have 'a smooth and cleanable floor (concrete'. <br /> asphalt. dean tarps and Smocitil wood ar-- acceptable) and coristruiAed to separate- food and food preoaration <br /> -areas from the Dublic. <br /> 0 bier specfN) <br /> Note, The only operations not required to provide andased booths are those which sell beverages from <br /> approved dispensers or prepackaged foods from approved SOLJrC.P-$. <br /> 1 Approved water for drinKing. utensil and hand washing will be provided in my tbootfi by the fok)wing methods: <br /> Approved bottled water <br /> -1 On-site hose bib that is connected to a potable water source <br /> Other(specify) <br /> &--c c4 is provided for my booth's ijse: E] Yes r7No <br /> am providing an accurate probe themiometpr to measure the hot and coed potentially hazardot;s <br /> foods during all biases of booth operation: r�-4fyes 0 No <br /> 9 1 am providing the following hot temperature control for the hot holding of at! potentially ha7ardic,,Us fc)CKJS above <br /> 135,7- <br /> Camp stove 31dstemo& hotel trays <br /> Double steamer '--f Steam tabie& lids <br /> Electric stove top Other(spec!f,! <br /> Noke Examnlas Orf poterifiaMy hazardous is inckide: meaL%� tamaierp;. cooked beans. rice. <br /> vogetables. potato satad. eggs,and dairy productz. <br /> T�.kjp EVEP?7 APP <br />