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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(bath for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> the festival;coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: ,�(.� ��� 1 Y1 c � �' `�' ��' ca�� i <br /> Date(s): ? 7 <br /> 2. The following is information about my organization/business: ( i �' (✓ U� ' <br /> j� U <br /> Name of organization/business_ �� �" t Cl 1 q`�' ���,v�,V� <br /> Address: �� <br /> Phone: /(,l� L 0 <br /> Alternate: <br /> 3. List food to be sold or given to the public: t2' 11�i <br /> 4. 1 am providing food that is NOT prepared at hom A Yes 0 No <br /> All food is prepared on- ite or is from approved commercial facilities- <br /> es No <br /> Name of facility: Phone:( ) <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackage food and food- re aration areas from P P om flies, <br /> dust and the public) <br /> ❑A lbooth with walls and ceiling constructed of ei er wood, canvas, plastic, similar material and fine mesh fly <br /> scree�i , <br /> ng, 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 /> 00.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. Apprdved water for drinking, utensil and hand washing will be provided in m booth b <br /> � y y the following methods: <br /> 0 Approved bottled water. <br /> 0 0 Lsite hose bib that isconnectedto a potable water source. <br /> 0 Other(specify):. <br /> 7. Electricity is provided for my booth's use: 0 Yes eNo <br /> 8. I amI�roviding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: 0 Yes 0 No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135�R <br /> ❑Ca[Tip stove 0 Sterno& hotel trays <br /> ❑Do�ble steamer 0 Steam table& lids 4 <br /> 0 Electric stove top ❑Other(specify) <br /> Note:i Examples of potentially hazardous food include: meats, tamales, cooked beans, rice <br /> Ii vegetables,potato salad,eggs,and dairy products. ' <br /> EHD 16-02 r Page 7 of 11 <br /> 08/01/16 TEMP EVENT APP <br />