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10. I am providing the following cold temperature control for the cold holding of potentially hazardous foods below TEMPORARY FOOD VENDOR'S APPLICATION 45°F IN food is used the following day,maintain below 41°F temperature): All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to `,�Ice chests ❑Refrigerator the festival coordinator three(3)weeks prior to this event. ❑Refrigerated truck ❑Ice bath and tubs ) I Other(a f 1 1. 1.NameofEvent:lAD1 VVINX` TWO V{`,S-1N �'n�,af�j Date(s): �-G-`�-`�7nl-)""— 2. The following is Information about my organization/business: it. 1 am providing the following Items within my booth for the sanitary cleaning of food preparation utensils: Name of organization/business::O,aI Q VS E]Three compartment sink. Address: JI i C)t.�Qi� �,�h('(UY�`1lotJ�ZJ � � a Lod( Cn q Jz4da OR ;kThree deep tubs(basins 6-8 inches minimum),one for soapy water,one for rinsing and one for a bleach `�,�.,n(7 'solkMon(one tablespoon of bleach per gallon of water). Phone: 120 )'?) - - IG h Alternate:( ) 1,�,�,,�,t 1� t- of v,� El Detergent,bleach,and wiping cloths(cleaning towels). 3. List food to be sold or given to the public.b Cod �1 IP P CJT owo k t\�f S C rab�`�'t!, ❑Tub to store wiping cloths in bleach solution. 4. 1 am providing food that is NOT prepared at homeAYes❑No �C 12, I am providing the following for adequate hand washing facilities,but separate from utensil wash within my All food is prepared on-site or is from approved commercial facilities:❑Yes❑No booth: Name of facility: Phone:( 1 E]Water supply dispenser with warm water at a minimum of 1D0°F(i.e.5-20 gallon container with spigot). Address of facility: One separate tub(bucket or basin)for the collection of rinseMreatewater. 5. 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from files, dust and the public) per towels and Pump-stvle soap container. A booth with walls and ceiling constructed of either wood,canvas,plastic,similar material and fine mesh fly 13. Names of responsible persons to be present in booth during all hours of operation: %cteening,completely enclosing open food areas. It will also have a smooth and cleanable floor(concrete, - . asphalt,clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation Please make of this——applicationin areas from the public. copy •'Important" All food vendor booths are subject to inspection. preparation for this event. A copy of this checklist must be inn the booth at all hours of El Other(specify): preparation and operation. Return original to festival coordinator three weeks prior to Note:The only operations not required to provide enclosed booths are those which sell beverages from this event. approved dispensers,or prepackaged foods from approved sources. 14. Completed by: Signature Title Date 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: 9 5:g(3a ❑Approved bottled water. Health Permit ,,,G„�„g [1M P.pYHvtl 1oxW ❑On-aite hose bib that is connected to a potable water source. ❑Other(specify): antro mre u..rnawn.r r« 9•'�pM tloYrs a..tlr 7. Electricity is provided for my booth's use:❑Yes❑No P,oPw srov. Boots must De on 8. I am providing an accurate probe therm r to measure the hot and cold holding of potentially hazardous concrete,r aphaa, . Au Plywood,or a Tarp. foods during all times of booth operation' Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above e°•'^•T'"" 135°F: tii� so.v•� n,nvwa« e�um vm wwx age I ❑Camp stove ❑Sterno&hotel trays ❑Double steamer ❑Steam table&lids w.w ❑Electric stove top ❑Other(specify) Ice Cooler Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, E.a.K.a.gaawoe w«r�.• s' vegetables,potato salad,eggs,and dairy products. «one e.aw ono n»aewa Page 7 of 11 TEMP EVENT APP P.ge 50 11 TEMP EVENT APP 642 END 1END 1 08I01116 08/01/1166