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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food Wdars(both for prcMt and non.-profit) are requirod tD return a signed and completed copy of this cljacjljst to <br /> thea fesfivOl 000rdirlator three(3)weeks P)'ior to this event, <br /> 1. I,Nmnsof Event <br /> 2, The follovAng Is Information AbOUt my organization/business, <br /> Name Of organlZationUsiness: <br /> Address: <br /> TT <br /> Phone: <br /> Alt ma* <br /> 3, Ust food to be solcl 01'given to tbo pwbllc.,,_IX" Ve- <br /> 4. 1 am providing food th. st Is bW prepared at:home,6yes <br /> All food Is prepared on- #t or is from approved commercia�,*.- <br /> I-facilitleOZY66 rj No <br /> Name of f*oility, Lopj <br /> phones =9 <br /> .Addmas e f8CjIity,,_4jj L=L-L7LL___ <br /> 5, 1 am providing a booth vA.h the fojjowjng: (to protect my unwAged food and food-preparation areas from njes, <br /> dust and the public) <br /> Z A booth with walls and coiling Constructed Of 81ther wood, canvas, plastic, $lMlIsf m8terial and fine me sh fly <br /> ScfsOmlng, 00mPlOtOlY enclosing open food area. <br /> asphalt, CiS811 tMT3 and smooth wood are accepst' lt will also have a smooth end clWsbit floor (concrete, <br /> MOS fF= gie public, ai�ie) and constructed to separate food and food preparation <br /> [3 Other(specify),, <br /> Note: The OnlY operations nOt required to pmylde enclosed booth& Ore ftse which sell beverages from <br /> approved dispensers, Or Pr$Packaged foods ftm approved sources, <br /> Q. Approved Water for drinking, utensil and hand washing wIll be provided IM my booth by the follow <br /> Ing methods, <br /> eApproved bottled water, <br /> C On-site hose bib that Is Connected to a potable water Soulte, <br /> El Other(sp9dfy)L <br /> 7• EJOCtricItY Is provided for my booth's use.,0 yes 0 No <br /> W providing an Qccurato Proe thermometer to ?asure the hot and Cold holding of potentially hazardous <br /> foods during all times of booth opatVion,,0 yes 2 NaN0 a <br /> I <br /> am P"Ovid1mg the fallovAng hot tempersture control for the hot holding of all poientially hazardous foods above <br /> i35"F: <br /> Camp stove CJ Sterno&hotel trays <br /> Double latearrier 13 SUSM table&lids <br /> ED Electric stove top C3 Other:;specify) <br /> Examples of potentially hazardous food Include: M68ts, tamales, cooked beans, fqce, <br /> ysgstAblss,Potato salad,0996r and dairy Product& <br /> t;FfiD 96••0 <br /> T <br /> EMP EVENTAPP <br /> 2/9 d S91,66996n? << PcnjccAAn7 IULJd U011.0Aq Alnniw <br />