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2017-01 - 12 11 : 16 Middle section print 2099557038 >> ?093699185 P 4/5 <br /> TEMPORARY FOOD VENDOWS APPLICATION <br /> All food vendors (both for profit and non-profit) arum r juirrerdd to return a signed and Completed ropy of this checkllst to <br /> the festivsl coordinator three(3)weeks prior to this evqnt, <br /> 1. �.Mange of�vat5t:, w <br /> P-: The following Is Information about my organizationtbus€nese: <br /> Mame of orgeni t€onibusiness; ( <br /> Phone: ( 210!3� - y 2— _ Alternate-, <br /> 3, List food to be sold or givon to the public t <br /> 4: 1 am providing food that Is=prepared at home! yesbKINO <br /> All fbod is prepared on-Sita or is from approvedcommercialfacll€tles: (�Yet[I No <br /> Name of facility: � f Phone,f 4Q1 <br /> Address of facility:_ - �� <br /> 5, l am providing a doth with the followng; (to protect my unpackaged food grid food-preparation areas from files, <br /> dust Ohd the public) <br /> E]A booth with wails and colilng constructed of either wood, ranvee, plastic,,SIMIlar nintedal,and fine mash fly <br /> sore6ning, COMPletaly enclosing open food areas, It krill also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth woad area ptadlp}and constructed to separate faad and food pr"ra(ion <br /> - areas from-the public-- - - - --- - — - <br /> " Cher(specify);.... ._ <br /> Notal The only operations not required to provide enclosed booths are those which sell f)everagea from <br /> approved dispensers, or prepaokagad foods from approved sources. <br /> 8, Approvad water for drinking,utensil and hand washing will be provided In try booth by the following nieftds; <br /> eApprovad bowed water. <br /> 0 On-s(te lose bib that Is connectad to a potable water source, <br /> E! Other("Oft <br /> 7, Electricity fa provided for my booth's use:' Yos CJ No <br /> 6, I am ptoviding an awurate probe thermometer to Measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operatlonr C]Yes 0 No <br /> 9. 1 em providing the following hot temperature Control for the loot holding of all potentially hazardous foody above <br /> 1351F= <br /> Q camp stoves 0 Sterno&hotel tree <br /> Double steamer 0 Stearn t6ble&lids <br /> C]Efear€c stave trap Ej{ether(Speolm <br /> Mote: Examples of potarttlially hazardous food Include: masts, tamales, cooked beams, rice, <br /> vegetables,potato salad,eggs,and dairy products, <br /> EHO 16_pV i�N�tlt 7 1 i <br /> iYMVI8 TEMP E�/t.N7 APO <br />