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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 three(3)weeks prior to this event. <br /> 'n -� <br /> 1. 1.Name of Event: I t`_I(��ZQ� iWl G1 <br /> 2. The following is information about my organizationUe iiiess: <br /> Name of organization/business: <br /> Address: -RA l(Mx H <br /> Phone: ( j�) 3� Alternate:( ) <br /> 3. List food to be sold or given to the public: 2) �� <br /> 4. 1 am providing food that is NOT prepared at home:l d"Yes❑No <br /> All food is prepared on-site or is from approved commercial facilities:[ Yes❑No <br /> Name of facility: Phone:( 1 <br /> Address of facility: <br /> 5. I am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑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 /> Other(specify): hvA lV `�'P 41— (7�47;e.lY'\,P <br /> Note: The only operations not required to provide enclosed booths are those wftich 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 /> ❑On-site hose bib that is connected to a potable water source. <br /> ff�(�)ther(specify): _Q) ICAY'°C -�aV\,L <br /> 7. Electricity is provided for my booth's use:((Yes❑No <br /> 8. 1 am providing an accurate probe thermorneterAo measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: es❑No <br /> 9_ 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑Stemo&hotel trays <br /> ❑Double steamer [team table&lids <br /> ❑Electric stove top [Other(specify) <br /> JVFZ— <br /> Note* Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato saTad,eggs,and dairy products. <br /> EHD 9602 Page 7 of 17 <br /> 7r18lSO TEMP EVENT APP <br />