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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3)weeks prior to this event- 1 1.Name of went: 0Of fl onl Date(s): �' Zj K 2. The following is information about my organization/business: Name of organization/business: L L'_..e4"V e' .C �f _,,C _ Address: �c 1!(�r� [�, S 1{ ) Phone: Altemate: ( } 3. List food to be sold or given to the public: 4. 1 am providing food that is NOT prepared at home:kjYes ❑ No All food is prepared on-site or is from approved commercial facilities: Yes ❑ No Name of facility: 4. phone. Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) l•�SA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑ Other(specify). Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources- 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: El Approved bottled water. R On-site hose bib that is connected to a potable water source. ❑ Other(specify): 7- Electricity is provided for my booth's use: ❑Yes f 6o 8- 1 am providing an accurate probe thermometer to m asure the hot and cold holding of potentially hazardous foods during all times of booth operation; [IYes 1171 No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F: ❑ camp stove ❑Stemo&hotel trays ❑ Double steamer ❑ Steam table&lids ® Elmlfi@ stove top ® Other(LipGcify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. EH[)16-02 Page 7 of'l TEMP EVENT APP 711al15