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( <br />1. <br />Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7.Yes No <br />8.the hot and cold holding of potentially hazardous <br />9. <br />135°F: <br />meats, tamales, cooked beans, rice, <br />Rage 7 of 11 TEMP EVENT APR <br />EHD 16-02 <br />08/01/16 <br />XJ7)___I <br />required to return a signed and completed copy of this checklist to <br />evpwfc^ <br />(-----<E^>viuoO> <br />the festival coordinator three (3) weeks prior to this <br />1. Name of Event: <br />ire control for the hot holding of all potentially hazardous foods above <br />s?^Yes □ No <br />PhoneBnS> n I\ _ n 1 <br />er to measure <br />Yeh No <br />this cl <br />All food is prepared on-site or is from a <br />Name of facility: \ J <br />Address of facility:_ <br />' ^sTandthe puW^cT f°"OWin9: (t° my unpackaSed food and food-preparation areas from flies, <br />areas fromTe p^bhc3 W0°d aCCeptab,e) and instructed to separate food and food preparation <br /> Other (specify): <br />NOte: Innrnvld °perations not to Provide enclosed booths are those 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 />SApproved bottled water. <br />EZI On-site hose bib that is connected to a potable water source. <br /> Other (specify):________ <br />Electricity is provided for my booth’s usej/g <br />I am providing an accurate probe thermo* <br />foods during all times of booth operation^ <br />I am providing the following hot tempered <br />Z] Camp stove EZ^terno & hotel trays <br />□ Double steamer Vf|feam table & lids <br /> Electric stove top Otdier (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />oitisirfess: J <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) <br />The following is information about my organization/bi <br />Name of organization/business: \ V <br />Address:1 <br /> . Alternate: <br />List food to be sold or given to the public: t <br />I am providing food that is NOT prepared at home:'^Yes No <br />, " '"^■oved commercial facilities: <br />e Qe/S <br />-) vHc-zZ I