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TEMF )RARY FOOD VE NDOR’S APPLICA'ON <br />1. <br />The following is informatio2. <br />q ru <br />Address: <br />( ^0 ) lipPhone: <br />3. <br />4. <br />Phone: ( <br />he following: (to protect my unpackaged food and fo i-preparation areas from flies,5. <br />areas from the public. <br /> Other (specify): <br />utensil and hand washing will be provided in my boc i by the following methods:6.Approved water for drinkin <br /> Approved bottled water <br /> On-site hose bib that is jnnected to a potable water source. <br /> Other (specify): <br />7.Electricity is provided for n <br />8.ding of potentially hazardous <br />o <br />9.hot temperature control for the hot holding of all pot itially hazardous foods above <br />meats, tar lies, cooked beans, rice, <br />TEMP EVENT APRPage 7 of 11EHD 16-02 <br />7/28/10 <br />I am providing an accurat <br />foods during all times of <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />[BvX booth with walls and <br />screening, completely en< <br />Note: The only operatior <br />approved dispense <br />I am providing a booth wit <br />dust and the public) <br />booth's use: Yes <br />probe thermometer to _mea$ure the hot and cold h <br />joth operation: Yes <br />eiling constructed of either wood, canvas, plastic, sii ilar material and fine mesh fly <br />sing open food areas. <br />not required to provide enclosed booths are tho s which sell beverages from <br />or prepackaged foods from approved sources. , <br />md cleanable floor (concrete, <br />ate food and food preparation <br />All food vendors (both for profit d non-profit) are require i to return a signed and corf|)leted copy of this checklist to <br />aeks prior to this event. <br />1 Siricu^ <br />I am providing the foliowin <br />135°F: <br />Name of organization/busiUss: <br />I am providing food that is <br />All food is prepared on-sitf >r is from approved commercial facilities: Yes <br />Name of facility: f <br />Address of facility: 1_ <br />It will also have a smooth <br />asphalt, clean tarps and |ooth wood are acceptable) and constructed to seps <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of po ntially hazardous food include: <br />vegetables, potati >alad, eggs, and dairy products. <br />List food to be sold or give to the public: <br />OT prepared at home: Yes ^No <br />the festival coordinator three (3) <br />1. Name of Event: L~odl <br />3 <br />) <br />_____ Alternate: ( <br />Date(s): <br />about my organization/business: <br />to