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PAGE 0315:57 916899101/05/2017 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />7. <br />ire the hot and cold holding of potentially hazardous8. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPP9g«7of-11 <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 /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br /> Steam table & lids <br />O Other (specify) <br />Approved water for drinking, utensil and hand washing will 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 />Date(s):_L^ZZ_21 <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />END 16-C2 <br />7/2a/io <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />■ dust and the public) <br />Nf 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 />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />All 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 /> Other (specify):_________—_________________________________________________________ <br />Electricity is provided for my booth’s use-.l^ Yes No <br />I am providing an accurate probe thermometer to measure the t <br />foods during all times of booth operation: O Yesj^f No <br />I am providing the following hot temperature control for the hofl holding of all potentially hazardous foods above <br />135°F: <br />Yes No <br />'hone: (____) <br />The following is information about my organization/business: <br />■ Name of organization/business:. <br />_A?6g ) CA/_____ <br />( 9/6 ) ^0-^)9 Alternate: <br />List food to be sold or given to the public; Ce>(Y\ <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: 3^*^- <br />Address of facility:__________