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Gina 20084585^p.1 n <br />FOOD VENDOR’S APPLICATION <br />3x0 viX\ <br />2. <br />3 <br />4 <br />5. <br />6, <br />9. <br />mMts, tamstes, cooked beans, oce1 <br />TLMrCvCNTAPR <br />EHO T«M» <br /> Stem® & hotel trajja <br /> steam tnwe & nos <br /> Other (specsfjr) <br />May 28 15 07:31 p <br /> Camp stow <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially nwonleus food Include; <br />vegetables, potato sated, eggs, and dairy products. <br /><- C> M r . <■ A |. -_ <br /> Alternate: -> *12 <br />\\c-Sx , f'Acx'r' J'A'OSVxV'GO <br />foods during all times cf tjooth operation; S Yes No <br />I am providing the following hot temperature control for the hot hotting of all potenteliy hazardous foods above <br />larr <br />All food vendors (both for proiX and non-profit) am required to return a signed and completed copy of trite checklist to <br />* feXvAtLS'DaMs): <br />the festival coordinator three (3) weeks prior to this event <br />. 1, Name of Event ~X I A"O'fx ^LA, <br />The following is information about my nrganizatkirvbusiness‘ <br />Nrneoforgan zarcortfbueiness \\ <br />Addraw:5M^>. <br />Phone' --------------------- <br />List food to be sold or gh®n to the public: <br />xi ep&x*-' <br />■ I am providing food that is |NQT prepared at home: [jj^Yes No <br />. All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facliiy: S-^-rcs S^<c-< Cc. ......... ....... ._______Phone: SSV/V>fo7----------------- <br />’ Address of racilihcgQM > ■ V «-< v •—--------------------------------------------------------- <br />I am providing a booth the following: (to protect my unpackegod food and foed-praparatton areas from flies, <br />dust and the publie) <br /> A booth with wans and celling constracted of eittier wood, cwwaa, plwtic, smiler material and fine mesh fly <br />screening, completely enclosing open food eraas. 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 prapBretion <br />areas from the public. <br />J0 Other (specify); p --------------- --------—.— ------ -------— -------------------— <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or propaclcaged foods from approved sources. <br />Approved water for drinking, utonbil and hand washing will be provided in my booth by the following methods; <br /> Approved bottled water, <br /> On-s>te hose bib trial is connected to a potable water source. <br />2'0 Other (specify): ,G Cum -ks------------------------—------7------——— --------- . .------------ <br />7. Electricity is provided for my booth's use: Yes ^No <br />8, J am providing an accurate probe thermometer to measure the hot and cold holding of potentially hacartfouS