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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event:1. <br />2 <br />Address: <br />Phone <br />■5 <br />2 <br />5. <br />Approved water for drinking, utensil and hand .'.ashing will be provioed in my booth by the following methods:6 <br />0 Approved bottled water <br /> On-site hose bib that is connected to a potable water source. <br />7 <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TFI/U' FVFNT Af’PF< <br />) <br />_;S' food to be sold or given to the public <br /> Sterno & hotel trays <br />p<l Steam table & lids <br /> Other (specify) <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 />MOUNTAIN HOUSE FARMERS MARKET <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Datn(s): YEAR <br />ROUND <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 />aspha t : can tarps are smooth wood are acceptable) and constructed to separate food and food pieparation <br />areas from the public. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home; 0 Yes No <br />A1 •'ood s prepared on-site or is from approved commercial facilities 0 Yes No <br />* .ame o‘‘ •acrzvu Qizrf ______________Phono ; ______ <br />Aaoress of facility: Pfci/MO WA/ / __________________________ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation aieas from flies, <br />dust and the public) <br /> Other (specify) —---------------—------------------------------ ---- <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the ii.'-i and cold holding of potentially hazardous <br />foods during all times of booth operation: Q Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 - <br />CA <br />Attornale I > 2rr <br />•^0 7 <br />Thc following is information about my organization/business: <br />Name of organization, business: Get il\\/ ic <br />3 < S'7 <br /> Other (specify): <br />Note: T!'e cr , sc cations not required to provide enclosed booths arc those which sell beverages from <br />app-oveo d.spenscrs or prepackagec foods from approved sources