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TEMPORARY FOOD V'ENDOR'S QPPUCATiON <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. 1.Name of Event: <br /> 2. The following is information about my organ ization�/buusin�ess: <br /> Name of organ ization/business: <br /> Address: / V <br /> Phone: ( ) 3&9 /C Alternate: ( ) <br /> 3. List food to be sold or given to the.public: <br /> i <br /> 4. 1 am providing food that is NOT prepared at home: ["Yes ❑ No <br /> r'IIr,0IS prepareon-site oris approved commercial facilities: <br /> GS. InJ <br /> No <br /> iuu u i LIv <br /> Name of facility: 4ntl x/10 --I i� Phone: (20S) <br /> Address of facility: V jf/C47-a- QQ k-c7Ot <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 /> �ther(specify): j- <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. Appr�ved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): f <br /> 7. Electricity is provided for my booth's use: Ii Yes ❑ No <br /> 8. 1 am providing an accurate probe thermomet r to 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 all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove �erno& hotel trays <br /> ❑ Double steamer ❑ Steam 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 /> 08/01/16 <br />