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<br />LJ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Phone; <br />3. <br />4. <br />5. <br />i <br />6. <br />7. <br />8.and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice,vegetables, potato salad, eggs, and dairy <br />PsseZoril <br />TEMP EVENT APP <br />13 <br />f <br />■ <br />Pl If , <br />fifths <br />fctffl Ki' -- <br />ilbifc <br />mi <br />All food vendors (both for profit and non-profit) ar» required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />t- 1. Name of Event: Lincoln Date(s) <br />The following is information about my organization/business <br />Name of organization/business: ............... ........... ........... <br />Address: f C ! t l ~>C_» _ ____________________________ _ ____/ <br />2^ ) '^/L7L L>ZZ Alternate: <br />List food to be sold or given to the public: Icx^ <br />I am providing food that is NOT prepared at home^jYes No <br />All food is prepared on-site qHsfrom approved commercial facilities: Yes No <br />Name of fadiity; -------------- ______________ Phone: ( ) <br />Address of facility:. <br />II <br />EHD 1^2 <br />1 Ifos^and 'the public)1 thS followin9: Protect: my unpackaged food and food-preparation areas from flies, <br /> 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 />area^fromthe’pubfic30^ Sm0°th WOod are accePtable) and constructed to separate food and food preparation <br />.^Tdther (specify): hlM" IrtgQ tj^~5Y~ _____________________ <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 sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />Q On-site hose bib that is connected to a potable water source. <br /> Other (specify): __________________ <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: O Yes No <br />' a135P/FOV'd'n9 the Jollg”g hot temperature control for the hot holding of all potentially hazardous foods above <br />N <br />O Camp stove Q stemo & hotel trays <br /> Double steamer Q steam & Ms <br /> Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.