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5 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />: = <br />Date(s): <br />~.z ■—.Z~ ZZ---Z <br />- :o the public: <br />C / C VtS o p o O / U c i< <br />6. <br /> Approved bottled water. <br />7. <br />8. <br />9. <br />TEMP EVENT APRPage 7 of 11=-□ '.=-22 <br />Ted to return a signed and completed copy of this checklist to <br />s- ze *.: 'z _ = ~ es = _ <br />£ I ! C>- A <br /><7/s'- <br />- -z-zz ?-:z- <br />~e = to::s z-z- .z s e.e- <br />■=-e t r A7l > /. <br />\=-e z-^z z.z <br />-tt'-ess c* teoility:. <br />=- providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br /> 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 />rga-zation/business: <br /> Camp stove Q Stemo & hotel trays <br /> Double steamer Steam table & lids (? es? , p f^o , Tl+ <br /> Electric stove top pother (specify) -n7 i ^6 prf <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, 17-0 r- <br />vegetables, potato salad, eggs, and dairy products. <br />^7^6 - VZOl A Alternate: ( 2^d ‘T) _ <br />::: "=: :s NOT prepared at home: Yes No <br />=*ec on-site or is from approved commercial facilities: S] Yes No <br />/gZ-Ar^> Qou4lme7 6 <br />5S / / O - A KeLL&-\ Pa. ST-Dgi^TD^ OA <br /> On-site hose bib that is connected to a potable water source. <br /> pother (specify): — ------------------------------------------- -----------------— ---------------------- <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ^Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: