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2092396131 10:SO:38 a.m. 05-31-2018 2/5 TEMPORARY FOOD VENDOR'S APPLICATION ' I All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks-prior to this event. 1. 1.Name of Event:MP CI- 1 jr-1r lUit�� fir K Date(s): 2. The following Is information about my organization/business: Name of organizationfbustness: AE j [ �'( Address: Phone: GI ) 7-�9 - 4 Alternate: c1(0 100� - u34 1f i 1 3. List food to be sold or given to the public: s �✓- 1 Z'W, �s t Svd v� a t,�.�t�t'S. t bS • I 4. 1 am providing food that Is NOT prepared at home: Yes❑No , All food Is prepared`-site or Is from approved commercial facilities:'KYes ❑ No Name of facility: Phone: aA5 1 ��, Address of facility:__ PS y6` 14 ' i i 6. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, j dust and the public) f 1 4 ❑ A booth with vralis and ceiling constructed of either wood, canvas, plastic, similar material end fine mesh fly I scfeening, completely enclosing open food areas, it will also have a smooth and cleanable floor (concrete, II asphalt,clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation z areas from the public. [g Other(specify): I Note: The only operations not required to provide enclosed booths are those which sell beverages from I j approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: j f V Approved bottled water. i On-site hose bib that is connected to a potable water source. 1 I , n Other(specify): 7. Electricity Is provided for my booth's use:[3'les ❑ No s. 1 am providing an accurate probe thermom�to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Q Yes❑No 0. t am providing the followin© hot temperature control for the hot holding of all potentially hazardous foods above r 135°l=: ❑ Camp stove ❑Stemo&hotel trays I Q-tSouble steamer ['Steam table&lids 1f ❑ Electric stove top ❑ Other(specify) I Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables,potato salad, eggs,and dairy products. i EHD 18 02 Page T of 11 TEMP EVENT APP 1 �rinnt; r I