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Mar.16.2011 1:59PM No.0365 P. 3 Mar. 16.2017 1;59PM No.0365 P. 2 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below TEMPORARY FOOD VENDOR'S APPLICATION 45'F(if food is used the following day,maintain below 4VF temperature): All food vendors(both for profit and non rot[ are g p copy ❑Ice chests ❑Refrigerator (b p nm-profit) required to return a signed and cora feted of this checklist to the festival coordinator three(3)weeks prior to this event. ❑Refrigerated truck ❑Ice bath and tubs 1y.`, f l ❑Other(specify) 1. 1.Name of Event: �� yA7��'[. rt7'C.tA �1 1�� Date(s): 1 2. The following Is information about my organlzalion/business: 11. 1 am providing the following hems within my booth for the sanitary cleaning of food preparation utensils: t Name of organizallon/buslness ❑Three compartment sink. OR El Three deep tubs(basins 6-8 inches minimum),one for soapy water,one for rinsing and one for a bleach r' r� - solution(one tablespoon of bleach per gallon of water). Phone: i " ID Ahemate }q) I a_ - 881'a�- ❑6 � r Detergent,bleach,and wiping cloths(cleaning towels). 3. List food to be sold or given to the public: �(C� �7ub to store wiping cloths in bleach solution. 4. 1 am providing food that is NOT prepared at home:1pYes❑No 12. 1 am providing the following for adequate hand washing facllftles,but separate from utensil wash within my All food Is prepared ,she or is from a proved cwm arc el fP�(14 . ?rYes❑No / /y /� booth Name of facility: P`t: y `1 phene: NOR—01' ❑Water supply dispenser with warm water at a minimum of 101(1 e.5-20 gallon container with spigot). Address of facility: g L,.rAL l I R(Qne separate tub(bucket or basin)for the collection of rinse/wastewater. 5. 1 am providing a booth with the following;(to protect my unpackaged food and food-preparation areas from fuss, dust and the public) ❑Paper towels and pump-style-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: screening,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 areas from the public. -Important— All food vendor booths are subject to Inspection. Please make a copy of this application In ❑Other(specify): preparation for this event. A copy of this checklist must be In the booth at all hours of pre aragon andZeratbin, Return original to festival coordinator three weeks prior to thl antNolo:Thaonly operations not required fo provide enclosed booths are those which sell beverages from Approved dispensers,or prepackaged foods from approved sources. 14. Cornplsted by:6. Approved Approved water for drinking,utensil and hand washing will be,provided In my booth by the following methods: Sin Lure Title bate roc". ❑Approved bottled water. � HealthPermllIF am r.pxn�aTwm. ❑On-site hose bib that Is connected to a potable water source, s••o a o.e r ❑Other(specify): cNrAo s°wr u•R 7. Flectdclty is provided for my booth's use:❑Yes❑No ms In . Porro 91ow e..m toNa wp,p tloM. Baolh le el be on 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous cone 1 wphelt. foods during all times of booth operatlona��j Yes❑No ; plywood,ar a carp. i 1 am providing the following hot temperature control for the hot holding of ell potentially hazardous foods above 135'F: s..Pr.awwr ram.w+. a.vnamwer oarbape ❑Camp stove mo&hotel trays -' if: ,„E„t,,,,m, Can ❑Double steamer ❑Steam table&lids nr- Ice L)Electric stove top ❑Other(specify) ,Cooler Vit;, oo�Nme wan Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, E•e.b.e,9.rF,wc,.ro:,enmwe. waw.,+ro..�+.« abrer r h.Aar.admr rmwar - vegetables,potato salad,eggs,and dairy products. pe�o aW1/182 Pepe 7 d 11 TEND EVENT APP bVotoe�. 2 Pao.s d 11 p TENP EVENT APP