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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 t(�this ayent. <br /> 1. 1.Name of Event: p) � �c'A�a-6e/-pay e'10'Q Date(s): <br /> 2. The following is information about my organizationtbusiness: <br /> Name of organization/business: <br /> Address: �1 ���}� 4 `5—I S\A 1, `���(i <br /> Phone: ( � ) J��, 'j��� 1� Alternate: (Qt1 ) /z,5e� <br /> 3. List food to be sold or given to the public: KL't;l <br /> 4. 1 am providing food that is NOT prepared at home: Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes❑ 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 /> reening, 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): <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 soyrces. <br /> 6. 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 <br /> /to a potable water source. <br /> Other(specify): maa +, `��L'�LY C l A-D <br /> 7. Electricity is provided for my booth's use: ❑Yes YNo <br /> 8. 1 am providing an accurate probe thermometer to measure a 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 ail potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑Stemo&hotel trays n ,I <br /> El Double steamer ❑ Steam table&lids 'v <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 /> COIVIPI-ETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEIMEN]_ <br />