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Date(s): /j/W/Z O?Z^/7 2/Z> <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9. <br />above <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />EHD 16-02 <br />7/26/10 <br />k <br />are those which sell beverages from <br /> Alternate: {2^ ) - 7-3 2 G, <br />. . /"’/3 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to retum a si9ned and comple,ed copy of ,his ctekfet to <br />1. 1. Name of Event: S 7~' Pte A______ <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: /JS/f fjAZ/rtrcLA <br />_______ <br />List food to be sold or given to the public: z <br />1 am providing food that is NOT prepared at home- m0 <br />AHfoodjs^repc^ is from approved commercial facilities: EZVes No <br />Name of facility: ---------------------------------------------- ---------------Phone: <br />Address of facility: <br />' XSS put’bfcjh With ,he f°"0W"’9: 90 prole':t my “"P8^811 f°°d a"d food-preparation areas from files, <br />2£rt0r,Trnmn2h and ,CeiS"9 constr,llc*ed ol either '"00'd oanras, plastic, similar material and fine mesh fc <br />screen ng completely enclosing open food areas. It will also have a smooth and cleanable floor /concrete7 <br />are^fromThe p^^ aCCeptabie) and instructed to separate food and food preparation <br /> Other (specify): __ _______________________ <br />Note: The only operations not required to provide enclosed booths arc <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 />EfApproved bottled water. <br />IZIT5n-site hose bib that is connected to a potable water source. <br /> Other (specify): ________________ <br />Electricity is provided for my booth’s use: EJ Yes No <br />I am providing an accurate probe thermometeiZo measure <br />foods during all times of booth operation: fc'H'es No <br />1 a™ PJ°vidin9the following hot temperature control for the hot holding of all potentially hazardous foods <br />0^Camp stove EfSterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.