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SEP-12-POIS 05:52 From: T, '192396131 Paee:3�3 <br /> r <br /> TEMPORARY FOOD VENDOR'S APPUCAMN <br /> Ail flood vendors(both for profit and non-pmfl)are required to retum a signed and completed copy of this cheiist to <br /> the festival coordinator thw(3)weeks prior to this event. } <br /> i. <br /> i_Marne of Event <br /> J Date(s). J�f� �"� I / <br /> 2. The following is i mm n a My a nizalion�itisSn�` <br /> Name of oraanizationJtzusisress: <br /> r f, <br /> Address ��} l� <br /> Y %�"' -� Altemate: ( ) <br /> Phone: - i <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that Is tjQ1 prepared at hornexYes❑No <br /> All food is prepared o"ite for isfrpm.appr•aved,comrnercU facilities: Yes Q.No <br /> Name of facility to, <br /> Phone. ! <br /> Address of facility. <br /> 5. lam providing a booth with the following:(to protect my unpackaged food and food-preparation area6 form files, <br /> dust and the public) I c <br /> XA boot}!with wails and ceiling consiTwc#ed of either wood, car►vas, plastic, similar material and fine mash By ening, completely enclosing open food areas. it will also have a smooth and cleanable floor (concrete, <br /> asphalt clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation � <br /> areas from the public. <br /> 0 Other(specify): <br /> Note: The only operations not required to provide.enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> i <br /> /O"iW hose-bits-that 19 dOnI to_a potatala-water source: - - - <br /> [p Other(specify): <br /> 7. Electricity is provided for my booth's use: ©YBs o <br /> S. I am providing an accurate probe thermorn to measure the hot and cold holding or potentially hazardous <br /> foods during all times of booth operation' Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all pgtentialty hazardous foods above <br /> 7 5T: <br /> Camp stove /Sterno &hotel trays <br /> ❑pouble steamer []StIbam table&lids i <br /> ❑ Electrio stove top ❑Other(speC]fy) f <br /> Note: Examples of potentially tazardous food Include: meats, tamalM cooked beans, rice, , <br /> vegetables,potato salad,eggs,and dairy products. <br /> E�tit tiZ PaQr 7 d ti TEMP EVENT APP <br /> if79n0 I <br /> 1 <br />