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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. <br /> 1 1 Name of Event' . MmIn MW, f LI(V_ Date(s): 16 (r- <br /> 2 The following is information aboutpmy organization/business: <br /> Name of organization/business: <br /> Address. J J hi-lily 11 `. <br /> Phone. (910 ) �1?� > I Altemate:(0D y5e,)2') <br /> 3. List food to be sold or given to the public: <br /> 4 1 am providing food that is NOT prepared at home: Yes ❑No <br /> All food is prepared on-site or is from approved commercial facilities: 4 Yes❑No <br /> t <br /> Name of facility: 1�1MM2110 MW L1MIPLA Phone: <br /> Address of facility: <br /> `) 1 am 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 /> I`tj Other(specify). <br /> Note: The only opera required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br /> �j Approved bottled water <br /> ❑ On-site hose bib that is connected to a potable water Source. <br /> h�jOther(specify) T_11(Wt) "IthgQ A�4L . <br /> 7. Electricity is provided for my booths use ` Yes❑ No <br /> 8 1 am providing an accurate probe thermo eter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:�fi Yes ❑ No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F <br /> ❑ Camp stove ❑ Sterno& hotel trays <br /> Double steamer ❑Steam table& lids <br /> (�Electric stove top ( J Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad, eggs, and dairy products. <br /> (AID 16.02 0; 1 11 TEMP EV[NT APP <br /> co/01116 <br />