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Environmental Health Department <br /><t^ 42^ fajdL^ <br />) <br />3. <br />4. <br />6. <br />9 <br />7. <br />8. <br />F 2O94S4-Ot38 <br />S^N J0O1N <br />------COUN"Y------- <br />1. Name of Event: <br />The following is information about my organization/busmess: <br />V~ <br /> Alternate: ( <br />Name of organization/business: <br />q -C C <br />» <br />> festival coordinator three (3) weeks prior to this event. <br />(OC-v— — • ■_____ <br />meats, tamales, cooked beans, rica. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />food vendors (both for profit and non-profit) are required to return a signed and completed copy o. this ch=ck <br /> D8te(5):£2^J^ <br />Address: <br />Phone: ( B) <br />List food to be sold or given to the public: <br />| am providing food that is NOT prepared at home: Q &No <br />Ail food is prepared on-site or is from approv co Phone: ( J----------------------------------- <br />Name of facility:---------- -------------------- ■ ----------------------------------------- fli <br />dust and the public) oiastic. similar matenal and fine mesh fly <br />^foad preparadm <br />screening, complexe y srnooth wood are accep <br />asphatL clean tarps a <br />areas from the public. _ <br />O Other tspecW------- ZiT^Drovide enclosed booths are those which sell beverages from <br />TrSnS. =?pSXrS Lds horn approved POPmea <br />approv ^nsi) gnd hand washing will be provided in my booth by the following methods: <br />Q Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />for my booth’s use:'0 Yes No <br />» am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation:'0 Yes No <br />l am providing the following hot temperature control fix the hot holding of all potentially hazardous foods above <br />ia5’F: <br />13 Camp stove LJ Stemo & hotel trays <br /> Double steamer Q Steam table & lids <br /> Electric stove top Other (specify) <br />Note: Examples of potentially hazardous food include: <br />yljgeUbtos, potato salad, eggs, and dairy products.