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No. 3280 iP...3jFAX No. 1209982'Q32Pae'P:c Southwest <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />□ate(s): 1. Name of Event.1. <br />2. <br />Address: <br />('Ml.Phone: <br />3. <br />4. <br />5. <br />6. <br />.pproyed bottled water. <br />in-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD IB-02 <br /> Cam# stove <br />d-Oouble steamer <br />0 Electric stove top <br /> 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 />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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />iC, y Jr <br />The following is information about my organization/business: <br /> Alternate: C^Pt) <br />'Ckos.-- ' <br />I am providing food that is NOT prepared at home: {ubYes 0 No <br />All food is prepared on-jsite or is from apj>rovjd_commercial facilities: [0-Yes No <br />Name of facility: 'V^Sp^-y.Q-Phone: (2^ k 4/ <br />Address of facility: 0^0 \ V-X ' ' .......... -________ <br />\ 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^Tbooth 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 />■ / z <br />H'Stefno & hotel trays <br />B^Steam table & lids <br /> Other (specify) <br />VCD/Feb. 2. 2017, 12:27PM <br />r Hij/UL/ LU X // 1 UV ll.Jl <br />Name of organization/business: <br />(TC j ki <br />List food to be sold or given to the public: A . C' v <br /> Other (specify):' _________________ <br />Electricity is provided for my booth's use: OLYes No <br />I am providing an accurate probe thermometeck/measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: (EWes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foci <br />135OF: <br />Is above <br />r T hut