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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. Name of Event: rocKco !c i ty Py <br />Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: G C. o <br />Address: L143 311 F'Opcceo- ctoe.o.w.ekciSZt <br />Phone: (90,q) S9 ()a cio Alternate:( ) tq• AM. <br />List food to be sold or given to the public: t 'Q. \E. S <br />I am providing food that is NOT prepared at home: Yes El No <br />All food is prepared on-site or is from approved commercial facilities:ciFIThoYense No ) <br />Name of facility: <br />Address of facility: <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />)i;A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />sc eening, 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 />0 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 />Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />Electricity is provided for my booth's use: c&Yes El 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: XYes El No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />K Camp stove El Sterno & hotel trays <br />El Double steamer El Steam table & lids <br />0 Electric stove top 0 Other (specify) <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />7/14/15