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. . �VrFi BWW .- V <br /> � <br /> � 80J {� hMhIk� r- <br /> �\��[� ]��� U � � N c, e �im a� I e 0 n� <br /> 'TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(bath for profit and ncm'pmfit)are required to return o signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior Uathis event. <br /> 1 1Namunf�want <br /> ' /(s): <br /> %. The following ia information about myorgxnbzaUon/bmsinmss: <br /> Name of organization/business: 0 A <br /> Address: of LAJ, J <br /> 3. List food to be sold or given to the public: <br /> 4. } providing e��| �� �Y �� ~- - ` <br /> /__41I o;d�i �repared on-site"or is from approved commercial facilities: F1 Yes M No <br /> __Zme of facility: Phone: <br /> Address offacility: <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 /> VA booth with walls and.ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> uoneoning, completely enclosing open food areas. It will also have a smooth and cleanable floor (conuneto. <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> 0 Other(mpecih0: <br /> Note: The only operations not required to provide enclosed booths are those which ne|| beverages hnm <br /> approved dispensers, or prepackaged foods from approved sources. <br /> G. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> �n�. <br /> *pprovodbaffledweter. <br /> F]On-site hose bib that ia connected bza potable water source. <br /> ` <br /> � --`~'~`, ~r~``'e"= ".v"v"x.xvu,vO 'es F1/v" <br /> 8. | am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times ofbooth operation: S-Yes F1 No <br /> 9. 1 am providing the following hot temperature' control for the hot holding of all potentially hazardous foods above <br /> . 135^F: <br /> t_ef' LJ Camp stove []Sterno&hotel trays <br /> LJ Double steamer Steam table&lids <br /> D Electric stove top 0 Other(apoci/y) <br /> Note: Enmmpfma of potentially hazardous food include: ,neats, temafea, cooked hee"s, rice. <br /> v=getab/es.pmtatoom)ad`eggw. anddairyproduotm <br /> �w |1are{konAvenue I Gtookkm. ��a}Uorn|u852O5i T 209408-34201 F 200464-0138 | vmmw.�govo /ekU <br /> P`^o /^'vz pon°r�`l r���CEVEwrAnp <br /> vmo/n <br />