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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profrt} are requrred to return a signed and completed copy of this clreckIS, to <br /> the festival coasdmato{three(3) weeks priorto this event <br /> 1, 1.Nameof Event ��— Date(s), _. 3 °��'# <br /> The Wow ng is information about my organ izatoatlbuslness <br /> r� <br /> Name of ofganrzaliiWbv%v)ess <br /> Address � *U—S�LAt 2�,3e _ .2iL <br /> Phare (�U y� _ ��-�`� Alternate: (`).1 <br /> 3 L st Ii ilo t�esold orgrven to the public <br /> 4 1 am providing food that rs!J T prepared at home 07 yes 0 No <br /> Al food s prepared onsle or b from approved comn-ercial facilties.IxYes❑ No <br /> Name of facility _ < Phone <br /> Addressoffacoity_ <br /> 5 1 am providing a bc�oth wrth the fal,owing (to protect my unpackaged food and food-preparation areas from fl'M <br /> dust and die public} <br /> A pool, with walb and ceiling constructed of either wood canvas plastic, sprnilar material and fine mesh fly <br /> screenng, comptetely enclosing open food areas it will also have a smooth and cleanable ttecr (concrete, <br /> asphalt.bean tarps and smooth wood are acceptable) and 000structed to separate food and food preparation <br /> areas from the puNiC <br /> JAQbier(specify) _,�.? LiQ�. ✓_'��+ 5 fp Gtr�fC <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 sound <br /> 6 Approved water for drinking, utensil and Rand wash ng will be provided in my booth by the following methods <br /> Approved battled water <br /> ❑On,s,te hose btrthat is connected to a potable water source <br /> 13 Other(spec fy) <br /> 7 Electricity rs provided for my booth's use [J Yes;S(No <br /> 0 1 am provdng an accurate probe therntorneler to measure the hot and cold hoidng of potentully hazardous <br /> foods during all times of booth operaticn ❑ Yes gNo <br /> S I am provding the tollowog hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F P/ <br /> ❑ camp stove 0 Sterno&hotel trays <br /> ❑Double steamer ❑Stearn table& lids <br /> Ej E Kx*PC stove top ❑ Otfter(spec,y) <br /> Note: Examples of potentially hazardous food include: treats, tarnates, cooked beans, rice, <br /> vegetables, potato salsd,eggs,and dairy products. <br /> EH(}16A2 w:, :'a"i I TEMP EWNT RP <br /> OftN 1/18 � <br />