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TEMPORARY FOOD VENDOR’S APPLICATION <br />I <br />2. <br />3. <br />4, <br />5. <br />6. <br />7. <br />8, <br />S. <br />meats, tamales, cooked beans, rice, <br />PngaZof 11 TEMP EVENT APP <br /> Camp stove <br /> Double steamer <br /> Electric stove (op <br />he hoj and cold holdin/of potentially hazardous <br />EHO 1002 <br />7/2fiH0 <br />the festival coordinator three (3) weeks prior to this event. <br />1. Dale(s): lo/L/^^11 <br /> Sterno & hotel trays <br /> Steam table & lids <br />[jf Other (specify) AT (f\ <br />Note: Examples of potentially hazardous food Include; <br />vegetables, potato salad, eggs, and dairy products. <br />M.y?indors •('bo*th f°r Pro,ft and non-profit) are required to return a signed and completed copy of this checklist to <br />u /m.. i._ —.t-!- - -enj <br />1. Name of Event:. <br />The following Is Information about my organization/buslness: <br />Name of organization/buslness: A/ <br />Address: //• 1^0 <br />Phone: (/p) 7^- « ^3 5 Alternate; <br />List food to be sold or given to (he public: /' <br />1 am providing food that Is NOT prepared at home: [^Ybs □ No J <br />All food Is prepared on-site or Is from aporoved commercial facilities: P’fves No <br />Name of facility: Phone: ? ^2 -t/ & <br />Address of facility; /? w i?/Z r',4.44 f <br />I 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 celling 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 construoted to separate food and food preparation <br />areas from the public. . <br />(71 Other (specify): r <br />Note: The only operations not required to provide enclosed booths are (hose which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved 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):ty/wK <br />Electricity Is provided for my booth’s use: Yes 0 No <br />I am providing an accurate probe thermometer to measure the.hqj <br />foods during all times of booth operation: E Yes No C <br />I ani providing (he following hot temperature control for the hot holding of all potentially hazardous foods above