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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): <br />7=~ <br />to the public: ~ re sr <br />/ C< <br />6. <br /> Approved bottled water. <br />7. <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous8. <br />9. <br />TEMP EVENT APPPass 7 cf 11=r0 15-32 <br />r-ess: _ <br />£ / / O - A <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during ail times of booth operation: pjYes Q No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />=~ providing a booth with the foltowing: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />O A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, 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 />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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />=-= re-zuires to return a signed and completed copy of this checklist to <br />5==^ = "Z' ic rs eve-t <br />Ph i I. bate(s): 1 7 <br />=-zrro=“.'zatton/business: <br />=- <br />-zz-ross z'reziizy:. <br />^^7 9 £6 - OZ. 0 7 , Alternate: (T) ^7 <br />z :~=: :s NOT prepared at home: Yes No <br />d on-site or is from approved commercial facilities: Yes No <br />/ CovcyZ/nGZ /Cgy/W^^Tphone: ( 2^5^ ^>6 <br />JCEUXM pn STDc<^TD/^ <br /> On-site hose bib that is connected to a potable water source. <br />pother (specify): TTZcACK <br />Electricity is provided for my booth’s use: Yes No <br /> Stemo & hotel trays <br /> Steam table & Ms iTW <br />^Other(specify) p Aj <br />meats, tamales, cooked beans, rice, I ^-<56 r-