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MU101J " "5/ 018 J : 1J:JZ PM PAGE 2/"-9 Fax Server <br /> TEMPOMRY FOOD VENDOR'S APPLICATION <br /> M food vendors(both for PA and coupe m are required to return a siy*d and cronipfeted IVY vl this dwickint to <br /> ttte Nstival m0f finatorthree(3l weeks prior to this event lf <br /> 1 1.Name Of Even t <br /> 1[i r-rrtY <br /> 2 Tye lollowing is InWmatton about my nryanm3bon/busir - <br /> Naerte of organs atiorAkusirms: { -- <br /> Addrriss: /J <br /> r <br /> f ,,i � C!I1 J r'Fs do 1,G`�✓ e',r>a> ICI <br /> 3. Lisl Toad to be Gold or given t0 the pubiiC awl T <br /> a, 1 am pfov?ding food that is NOT prepared at home: Yes❑No <br /> All food is prepared on-efts or 16 from moved OxM%emJat facilities: [ Yes C No <br /> Name a)facility: phone:r7 let S!4 e 7 y <br /> Address of faclfiry' f w t i <br /> 5. l am providing a booth with the f0cvwing:(to protect my unpadsaged food and food-preparation areas from flies <br /> dust and the public) <br /> ❑A booth with wails and ceiling consewled of either woad,canvas.plastic,similar mgtenal and fine mesh fly <br /> scpWing, oorrplebety enclosing open food Arms. It will also have a smooth and CkWWWble f4MF (concrete, <br /> &nphatt dean tarp`and smooth wood are acceptable)and oorwtrucled to separWift food and f0o4 preparation <br /> areas froth the public. n f <br /> [id0thar(:may): rc r,�& <br /> {hpte: The o" operabone not required to provide endoGM boryths are aloes which sell beverages from <br /> approved dtapensers,or prepadke foods from approved swFCFm <br /> 6 Appmved water for drinking,utens0.and hard warhing will be Provided in my booth by the foci mu)9 method". <br /> ❑Approved botf w water. <br /> ❑On-alte hvss b4b that ie connected to a potable water source. <br /> PrMer(spay)' r� `'E-o c e r Aj- <br /> 7. Bectridty is provided for my booth's use:❑Yes I A O <br /> g I am provsdmg an eocuroha probe themes rHftT to rot sure the hot and cold holding of peten► ty hazardous <br /> foods during aft tunes al booth operation:❑Yes ONO rU •rC S •A.,�Cs <br /> 9. 1 am providing the tolloWng hot Wnpefalure control for the Not holding of all potentl*hazarcimm foods above <br /> 135"F: <br /> 0 camp sbo a Starrto 6 hotel treys <br /> ©Double stemnw ❑,_,/Steam trtAu&lids �] <br /> ❑Electric stove top R'&her(t Ihl) r1 f A N rtc� { rrKl <br /> Noft; EYAMPWO of poWM"lly hazardous too Include: meats, tamales. cooked beans, rka, <br /> veg9tabtas,"to salad.eggs,and dairy products. <br /> TF4PeVEN1 APP <br /> ENO 76-V1 <br /> rrt0vt o <br />