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I".. I.Name of Event:1. 2. Address: Phone: 3. 4. 5. 6. 7. 8. 9. vegetables, potato salad, eggs, and dairy products. TEMP EVENT APRPage 7 of 11EHD 16-02 08/01/16 Sterno & hotel trays Steam table & lids Other (specify) TEMPORARY FOOD VENDOR’S APPLICATION required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 0 Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food include: I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood canvas, plastic, similar material and fine mesh fly ' j areas It will also have a smooth and cleanabie noor ^concrete, are acceptable) and constructed to separate food and food preparation Alternate: ) List food to be sold or given to the public:------/ ^1!------1 / I am providing food that is NOT prepared at home: |FfYes 0 No All food is prepared ortsite or is from approved commercial facilities: 0'Yes No ,, Phone: (L Name of facility: ---------------------------------------------------------------------- Address of facility: _________ ______ Date(s): //? meats, tamales, cooked beans, rice. screening, completely enclosing open food asphalt, clean tarps and smooth wood areas from the public. fVother (specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other (specify): / Lc j Electricity is provided for my booth’s use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: M Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: All food vendors (both for profit and non-profit) are Fesj- The following is information about my organization/business. Name of organization/business: Cotyudry () yte'T -^8!