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f <br /> TEiViPGRHRY FOOD VEWDGR'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(3)weeks prior to this event <br /> 1 <br /> Date(s): <br /> 1 Name of Event: <br /> _ <br /> 2. The following is information about my organization/business" <br /> Name of organization/business <br /> Address: <br /> Phone: �' CAlternate: <br /> 'ry'`( <br /> ( l J ) �^ <br /> 3. List food to be sold or given to the public: �kC��'����e <br /> 4. 1 am providing food that is NOT prepared at home:p Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ❑ Yes No <br /> Name of facility: i f11 �E j �'� r: ,.j��-'I Phone= i, rrv � <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 /> ❑ 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 /> 5. Approved water for drinking; utensil and hand washing will be provided in my booth by the fo({p F in <br /> w 9.me h ds< <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source, t <br /> ❑ Other n,:eci(s y) <br /> p 'J/' <br /> -.,tB 2y x3Yi,i y" <br /> 7. Electricity is provided for my booth's use: ❑ Yes No <br /> 8 I am providing an accurate probe thermometer to me <br /> foods during all times of booth operation; r Yes ❑measure the hat and c o,o hey�pna og �yotert ally n�,zardous <br /> J / <br /> am providing the following hot temperature control for the hot hole r of 611 otertttlf <br /> 13F`F Y, ardt. f . . . ve. <br /> [j Camp stove <br /> ❑ Sterno & hotel trays <br /> y ❑ Double steamer <br /> ❑ Steam table & lids <br /> t, Electric stove top <br /> Other(specify) <br /> Note: Examples of <br /> potentially hazardous f <br /> potato salad, eggs, and dairy productstle 4a se8h' "r"k <br /> vegetables, <br /> �x- 1 �¢ p <br /> 'Page 7 of 7 i <br />