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sAN Jl1A011i i' <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(b olh for profit and non-profit)aro adquirud to return a signed aald compWad copy of this checklist to <br /> lino lestival coordinator three(3)weeks prior to this event. <br /> 1- 1,Ni-rnae 0t Event: EOMI W1NF I"ESTfVAL — - v - - --wlo(s): APRIL 6.1014 <br /> 2. The following is information nbotif my organizationlhuslness. <br /> Narne of organizationfbusinass: /n <br /> Arkiress: ` J r -- 4�I�, r�._e.� Z, l..f•l__�� <br /> llhona (�� (if')---� U:�c ._._�i l-� �.__..__.._.._ Alternate:( D___.... .. <br /> 3 list food to bosold orgivrna to the public: <br /> 4• 1 am providing food that Is=preprlred at home Yes n No <br /> All fund is prepared on-rile or Is from approved coninier6al facilities: Yes❑No <br /> Name of facility: -,7:1� C.L•�.{ .. �'._�..1�<. .1=u� _Phone; -VIA, <br /> Address of facitily:_ <br /> 5. 1 am providing a booth with the following;(to protect my unpackagod food and food-preparation areas from flies, <br /> cusl and the public) <br /> .�booth with walls and coiling cunsiniclod of olther wood,canvas,plastic,similar material and fine mosh fly <br /> cre0ninq, completely enclosing open food ares. It wilt also have a smooth and cleanable floor(concrete, <br /> asphalt,clean larps and smooth wood art)acceptab(o)and constructed In,eparaln food and food preparation <br /> areas from 1110 public. <br /> i_I Other(specify): ,_.....-_-- <br /> Note; The only operations iwt fequlr0d 10 provide 011closed hoollTs arra those which sell bc:vor;agos from <br /> approved dispensers,or prPjwkagcd foods from approved sources. <br /> B. Approvod water for drinking,utensil a-id hnrid washing will be provided in my booth by the fuflowing methods: <br /> (.J Approved bottled water. <br /> On-silo host:bib that is connected to a polobl0 water source. l <br /> Othor(specify): ` c s'Jli'��. (_uvtJ_4:.Vie <br /> �. Electrical is ovldod For m booth's use: T-- <br /> Y Pr y ��Yes�+Io <br /> H. I aln pfovidinc3;in accurate probe thermometer to moasure the hot and cold holding of potentially hazardous <br /> fonds during all times of booth operationf I Yes[]No f,5 f Jj <br /> q I am providing the following hot temperalurrr control for the hot holding of all potonlWly hazardous foods above <br /> 135"F' <br /> Camp stov0 [I Sturno&hotel trays <br /> {:)Double steamer ❑Stearn tablo&lid., Imo' <br /> Electric stove top ❑Qlhor(specify) <br /> Note: Examples of potentially hazardous food include: moats, tamales, cooked beans, rice. <br /> vegetables,potato saind,eggs,and dairy products. <br /> `.t. ) i 10.- ,!; .7!, •I 1 <br /> I- Ill 711.1)1 Pal !0!11 KUPEVFYTAPP <br /> 1'r'S•17 <br />