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TEMPORARY FOOD VENDOR'S APPLICATION <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 thr 3)weeks prior to this event. <br /> 1. I-Name of Event: <br /> — L' JC ►� f,�%2l� Date(s): <br /> 2. The following is information about myiiorganization/business:l <br /> Name of organization/business: LC-) l Ce,- <br /> Address: t t'1 Or . -'I �44 ��- �� J 3 � 7 <br /> Phone: (` 1} '�._ J`� G <br /> tt Alternate: <br /> 3. List food to be sold or given to the public: I/yti f!�`' � , <br /> 4. 1 am providing food that is NOT prepared at home:(/Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:[ Yes.[]No <br /> Name of facility: rn 'W <br /> Address of facility: Phone:( } <br /> 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> 0 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 /> asphalt,clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> 1 <br /> LJ 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 /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> Q On-site hose bib that is connected to a�po�taable water source. <br /> Other(specify): ,k (-c r- 4 i",f/ i, ,V," <br /> 7. Electricity is provided for my booth's use:L]YesNo <br /> 8, tam providing an accurate probe thermomet r to measure the hot and cold holding Of potentially hazardous <br /> foods during all times of booth operation:RYes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> Camp stove ❑Sterno&hotel trays❑Double steamer ❑ fl 1 <br /> Steam table&lids ! J�k <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked Means, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> EHD 15.02 <br /> 7128110 Page 7of 11 <br /> TEMP EVENT APP <br />