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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event 1.Date(s): <br />2. <br />Name of organizationTbusiness: <br />Address: <br />(2^?)Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />6. <br /> Other (specify): <br />Yes NoElectricity is provided for my booth's7. <br />8. <br />I am provicfing the fbltowing hot temperature control for the hot holding of aN potentially hazardous foods above9. <br />135T: <br />meats, tamales, cooked beans, rice, <br />PageToril TEMP EVENT APPEH015-02 <br />7/14115 <br /> Stemo & hotel trays <br /> Steam table & fids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />) <br />Approved water for drinking, utensil and hand washing wil be provided In my booth by the following methods: <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />I am providing food that is NOT prepared at home( <br />AH food is prepared on-site or is from approved coi <br />Name of facility: <br />Address of facHity: <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following is information about my organization/business: <br />Shot', <br /> Alternate: ( <br />/<jg-, <br />I am providing a booth with the foBowing: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />/^A booth with waits and ceiling constructed rrf either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It wia also have a smooth and cteanable floor (concrete, <br />asphatt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Note: The only operations not required to provide enclosed booths are those which se# beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />Al 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 />Yes No <br />ercial facffitiesj^Yes No <br />___________Phone: I 1