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Environmental Health Department <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />connected to a potable water source. <br />7. <br />8. <br />9. <br />______________ <br />^444 Oj^ <br />)_ <br />and completed copy of thte checklist to <br />7A <^7/7-^- / <br />tamalM, cooked beans, rice, <br />“ WIN <br />Grectnesit i/roivi lirre, <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-HSXttEsSSKSKKS- —— <br />1 • 1.Name of Event <br />2- The following is Information about my oiganlzatlon/bualness: <br />Name of organizatiotVbuslneBs: & <br />AddnB88: 73^/ A <br />PhOn°: )J5^5A£ } <br />Z4^Z<^ AfZ, „nr , <br />I «m provWInfl food thrt to Jjfii pwpanrt at ho^. |^M g No <br />ZTJSTSXT r——a * <br />Address of facflltv: -----1 1—T3,ona: 5^5-45^/1 pu^1 SXoX and f^pafotfon afoaa <br />™and fl"» "»* «y 2S« Xar,d <br /> Other (specify):______ _____ <br />^Approved bottled water. <br /> On-elte hose bib that is <br /> other (specify): <br /> b°°<h,« Ikh'e. no-------------------------------------------------- <br />I a^^wnflSL*""*" N^1* **“ hot and cold holding of potentially hazardous <br />□StemoS hotel trays <br />“°°ubto stoamer □Steam tabla illds <br /> Eleotrio stove top Other (apeoty) <br />TB«>Ev»rrAPP