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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to retum 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 /> tj <br /> '7 <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: �(A � ��n��`1 <br /> Address: ?-7, 5 S c ck<z�/ l) N, P �G�CC���y� C° �,Ac 06'� <br /> Phone: ( �,vl ) ( `� C, ( Alternate: (,Zbj <br /> 3_ List food to be sold or given to the public: V -t <br /> 4. 1 am providing food that is NOT prepared at home: �❑No <br /> All food is prepared on-site or is from approved commercial facilities:Ues❑No <br /> Name of facility: (�`�r ` 7cn ^1 Phone: C b� 7 ) <br /> Address of facility: -LZ_ 1) I 7� c�( .V,,�Jc k\ �-Q-_ <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> ;dWst an public) <br /> with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> ening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, dean 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 /> 6. Appro for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> 11 ppr botNed water. <br /> site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑Yes o <br /> B. I am providing an accurate probe thermometer to re the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes <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 ❑Stemo&hotel trays 1 N <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑ [� <br /> Electric stove top .0tt'er(specify) L <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />