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<br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1.1, Name of Event: <br />2. <br />Name of organization/business: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />,pprgyed bottled water. <br />'n-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />135°F: <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APPEHD IB-02 <br />■ <br /> Other (specify): <br />Electricity Is provided for my booth's use: DLYes No <br />measure the hot and cold holding of potentially hazardous <br /> No <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 />ES^^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 />B <br />I am providing food that is NOT prepared at home: H'Yes Q No <br />All food is prepared on-jSite or is from apjoroved commercial facilities: Cj-Yes No <br />Name of facility: ' VA cfr? Phone: I- <br />Address of facility: Q.Vo \ ~ <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 />■"NiCWgC.v <br /> Caip-jd stove <br />I^.Oouble steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />\ C La <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 />I am providing an accurate probe thermometerte <br />foods during all times of booth operation: (3"Yes <br />_____ _ Alternate: C^Pt). B <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foo^s above <br />• .XL0'Stemo & hotel trays <br />[wfSteam table &. lids <br /> Other (specify) <br />BBL/ <br />^-4) '1 <br />The following is information about my organization/business: <br />Address: /-AXf I lk-1 <br />List food to be sold or given to the public: ~ \ C'\.