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TEMPORARY FOOD VENDOR'S APPLICATIONL 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: A^J~ , C R'wss P—O S W t /c'M e✓/0 cy o��' Dl --Date(s): e-OAlm.. 2. The following is Information about my organization/business: a a i 4 Name of organization/business: ui l f I - QQ--G. Address: 1' rl rl ' Rhone: Qct I O(0 S-= ?SZ O _ Alternate:(q Ilp )JH 9 -2lv 0,22 , 3. List food to be sold or given to the public. 4. 1 am providing food that is NOT prepared.at home: Yes Q No All food is prepared on�site or is from approved commercial facilities: Yes❑No Name of facility: QAt ' V'I Phone I�.1 8 - , 1'l� Address of facility: .� 5. I am providing a booth with the'following:(to protect my unpackaged food and food-preparation areas from flies, t dust and the public) scrc A booth with walls and ceiling constructed of either wood,canvas, plastic,similar material and fine mesh fly ning, completely enclosing open food,areas. It will also have a smooth and cleanable floor(concrete, asphalt, clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from 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: LApproved bottled water. On-site hose bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my booth's use.gYes Q No 8. 1 am providing an accurate probe thermor to measure the hot and cold holding of potentially hazardous l foods during all times of booth operation. Yes❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135OF: ❑Camp stove 0 Stemo&hotel trays ❑ Double steamer ❑Steam table&lidscj0GLJ ❑ Electric stove top v�Other(specify) `� �� VNote: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. COMPLETE BOTH SIDES AND RETURN WITH EXHIBITORAGREEMENT