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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three weeks prior to this event. <br /> 1. 1.Name of Event:. C'S �j ��- Q Date(s) <br /> 2. The following is information about my organization/business- <br /> Name of organization/business:___:F ' •, ��� � <br /> Address: (� � -tt 19 <br /> Phone: (Z� ) Alternate:(-ZO7 <br /> 3. List food to be sold or given to the public: 0�1,S4_CA 1 6r-.3T <br /> 4. 1 am providing food that is NOT prepared at home: (lees❑No <br /> All food is prepared oae or is from approved commerlial facilities: Ores❑ No <br /> Name of facility. Phone: 0.07 — <br /> Address of facility: <br /> 5, 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> L A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> ❑Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br /> Approved bottled water. <br /> �n-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: LYes❑ No <br /> e. I am providing an accurate probe thermoeto measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation,:Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of afl potentially hazardous foods above <br /> 135°F: <br /> ❑ camp stove ) St-emo&hotel trays ' <br /> ❑ Double steamerteam table& lids <br /> ❑Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 06/01!18 <br />