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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 Event: S©w r; c%•�� c` Date(s): ct Z' 1 2. The following is information about my organizationibusiness: Name of organization/business: r,�� S Address: 2-0� Phone: ( ` ) 4 c(d -3 Alternate:( } 3. List food to be sold or given to the public: -d`.�z.1'+�r. c�c�a i:ry, I—Af�,; _L_A_f 4. 1 am providing food that is NOT prepared at home:0 Yes❑No ' All food is prepared on-site or is from approved commercial facilities:[(Yes[]No Name of facility: Phone:[ �:} t{c c z.4 Address of facility: 'z-oc)i [,A c,kke� 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A 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. EOther(specify): C-90A 1 ;0 r C Note: The only operations not required•fo provid .ehclosed booths are those which sell beverages from approved dispensers,or prepackaged_oodom approved sources. 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: [I Approved bottled water. El On-site hose bib that is connected to a potable water source. [Other(specify): 3 ©�� S��,L., 4 d i1�.• n� S -��n 7. Electricity is provided for my booth's use: Yes❑No 8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:I,Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°I=: Camp stove / ❑Sterno&hotel trays Double steamer ®Steam table&lids ❑Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. EH D 96-02 Page 7 of 11 M8110 TEMP EVENT APP