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TEMPORARY FOOD VENDOR'S APPUCATiON <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 /> 1. 1.Name of Event: -22t/i_-r'.t eG'`e& Oate(s): < ,�� <br /> 2. 7ne following is information about my organization/business: <br /> Name of organization/business: CJ Z,4.7 CT <br /> Address: <br /> Phone: ( Q�j —% Alternate: ( r ) <br /> 3. List food to be sold or given to the public: GJ �Leli_� <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: i Yes❑ No <br /> Name of facility. Phone: <br /> Address of facility: <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 /> It/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): <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 /> 5. Apprro/oved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ErApproved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes r\o <br /> 8. am providing an accurate probe thermomet r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes❑ No <br /> 3. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑camp stove ❑ S-temc&hotel trays <br /> ❑ Double steamer ❑ Steam table&[Ids <br /> ❑ Electric stove top [i�'6ther(specify) <br /> ;°ors <br /> Nate: Examples of potentially hazardous food include: meats, t2m afes, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> EHD 16-C2. Page 7 of 11 TEMP EVENT APP <br />