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1 <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />food include:meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />EHD 16-02 <br />7/14/15 <br />J81 Stemo & hotel trays <br /> Steam table & lids <br />KJ Other (specify) <br />Note: Examples of potentially hazardous f__J <br />vegetables, potato salad, eggs, and dairy products. <br />v^^!Ure the ho' and hold'"9 potentially hazardous <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />to return a si9ned and comp,eted °f this td <br />1-Name of EventZ^/ z Date(s). <br />The following is information about my organization/business: <br />Name of organization/business: <br />Phone. Alternate: ( <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: tXl Yes Q No <br />All food is prepared on-site or is from approved commercial facilities _g] Yes No <br />Name of facility Phone: <br />Address of facility: <br />' ^s^and Se puWi^ fO,,OWin9: (t° my unpacka9ed food *nd food-preparation areas from flies, <br />A booth with walls and ceiling constructed of either wood, canvas plastic similar material and finp m«ch <br /> Other (specify):____ <br />Note: The only operations not required to provide enclosed booths are those which sell beveraoes from <br />approved dispensers, or prepackaged foods from approved sources. 9 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />JS.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 r~_ ‘ 1 ...w^ <br />foods during all times of booth operation: jxj Yes [J No <br />' a1'^?'idin9 the fOllOWing h0' ‘^Perature control for the hot holding of all potentially hazardous foods above <br />Camp stove <br />[ZJ Double steamer <br /> Electric stove top