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: ( Environmental Health Department <br /> C 0 U N T`r...._......... <br /> vows <br /> 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 to this event. <br /> cw Ral r x `•,,�C�9 r`�y 9 `;�c tic—6ate(s): <br /> 1. 1.Name�of Event: ��,a-�� � � ,� <br /> 2. The following is information about my organization/business: <br /> Name of,organization/business: <br /> Addresl;, 1-7 <br /> AA <br /> Phone: ( `��) � ' _ .] Alternate: (2 , 1) <br /> 3. List food to be sold or given to the public: (:Loo kv,% ` " <br /> 4. I am providing food that i C <br /> �repared at home: L�9 Yes [I No <br /> All foQd...s_pTepared 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 /> V A booth with walls and ceiling 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 constructed to separate food and food preparation <br /> areas from the public. <br /> ❑ Other(specify): <br /> 'I Note: ITS e only operations not required to provide enclosed booths are those which sell beverages from <br /> a proved dispensers, or prepackaged foods from approved sources. <br /> 6 Approy e� water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Ap r ,ved bottled water. <br /> ❑ On s�te hose bib that is connected to a potable water source. <br /> ❑ Othe�l(specify): <br /> 7� Electrici y is provided for my booth's use:Ig Yes ❑ No <br /> 8, 1 am 'rviding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> food uring all times of booth operation: , Yes ❑ No <br /> I am p iding the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 13AIR <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top El Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />