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TEMPORARY FOOD VENDOR'S APPUCA M <br /> Ail 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 /> 1. 1.Name of Event: <br /> 2. "Idle following is information about my organizatioribusiness: <br /> Name of organization/business: R e, <br /> Address: ' <br /> Phone: Alternate: , aLs; a <br /> 3. List food to be sold or given to the public: r¢ Ff . <br /> 4. 1 am providing food that is NOT prepared at home:,] Yes ❑ No <br /> All food is prepared on-site or iyTom approved commercial facilities: aYes ❑ No <br /> t\Namp of far-.ility: <br /> Address of facility:19 �' w _ :�• w" - ,Inz:.11_0 `,_,�: ""e, L" <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 /> �Q A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, curnpieieiy enciu-; t5 open food careers. it 'VAI aiso ihave a sn-too:ii and 4iaanab a 'cGo '(00ii1 L< , <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> ❑ Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved 6iSpensei's, or prep acIk agsed'fo ds Iroai approved souscas. <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 /> On-site hose bib that is connected to a potable water source. <br /> jJ Other(specify). <br /> 7. Electricity is provided for my booth's use: 2 Yes ❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation�'U Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous TOOGs above <br /> 135°F: <br /> Camp stove ❑ Sterno&hotel trays <br /> Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentiaily hazardous rood include: meats, tamales, cooled beans, vice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 8/1/1S <br />