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09/07/2007 09:03 7634247637 <br />T+As c4ur Mart <br />gr <br />QUALITY DRYWALL PAGE 05 <br />APPLICATION FOR TEMPORARY FOOD SERVICE LICENSE <br />SAINT PAUL - RAMSEY COUNTY DEPARTMENT OF PUBLIC HEALTH <br />ENVIRONMENTAL HEALTH SECTION, Community Environmental Health Program <br />2755 White Bear Avenue North, Suite 350, Maplewood, MN 55109 -1320 <br />Telephone: 651466 -1199 Fax: 651-266-1177 <br />This application must be received at least two (2) business days before the event. Please be specific and °tint legfhty. <br />This nrmliratinn must he accompanteq with the liOCnse Tee at A . reivA e. C uv 0.o',manti1iono. <br />LICENSEE (organization serving food): <br />NAME OF EVENT: Gf_ o Li <br />t• f,',e 1-G01604 �eT1 f <br />LOCATION OFEVEN 5fieiia1 pc,in`4.6 4.}11tct1 -Mid tJ Local *6/ <br />3aos Ga,,,,,, - Pnuegtit o la J4,.wf,v -5517 kPItb-.t CI <br />DATE AND.TIME dF EVENT: <br />ict-S4,,yy Ot4o lour 3O AoO7 Lf'9 prh <br />; <br />PERSON II1 CHARGE OF FOOD .OPERATION: <br />Name Home Telephone <br />Address Daytime Telephone <br />LIST ALL FOOD AND BEVERAGE ITEMS ON MENU. Identify source; for example, name of grocery store. Hartle. <br />prepared foods are NOT permitted, Attach additional sheet if more space is necessary. <br />Sourer. <br />Stare*: <br />Source: <br />Soorct <br />Sonny: <br />Sant:et <br />Scum: .. <br />LIST EQUIPMENT TO BE USED TO COOK AND MAINTAIN FOOD ABOVE 140 °F AND TO KEEP FOOD BELOW <br />41 °F. iildicatc.if used for storage, preparation, or holding. Mechanical refrigeration is required for cold foods. All <br />• <br />w..w...� .... °....... a.. a. _ <br />Use: Storage - Prep, _ Holding— <br />Use: Storage _ Prep. _ Holding <br />Use: Storage _ Prep. Holding <br />Use: Storage Prep. Holding _„•_- <br />— _ <br />DESCRWBE WHEN AND WHERE FOOD WILL BE PREPARED: <br />CONTINUED ON REVERSE SIDE <br />i"ee Oa wtht stAcd l *s ta' i,.Aa a t <br />6- <br />