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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 (3) weeks prior to this event. <br /> 1. 1.Name of Event: L37 �te(s): q-f 3• IqJd <br /> 2. The following is information about myorganization/business: <br /> Name of organization/business:-tAAA,ti it cc � <br /> Address LutR - r <br /> Phone: (ZaT ) '7j � C—t 7y7j-Ul2`a� Alternate: { ) <br /> 3. List food to be sold or given to the public: QQ (am C n . br -be--a go I q j <br /> 4. 1 am providing food that is �QTrepared at home: [4- es ❑ No AT Ra-;a Ti oV.A1--1T <br /> All food is prepared on-site or is from approved commercial facilities: P"�es ❑ No <br /> Name of facility: Phone: ( } <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): -JOY_ ZQ <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 /> M"Approved bottled water. <br /> [�On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> T Electricity is provided for my booth's use: N Yes ❑ No <br /> 8. 1 am providing an accurate probe thermomee to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: LJ 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 �terno & 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 15-02 Page 7 of 11 TEMP EVENT APP 65 <br /> 7114115 <br />