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Date(s): i. 2. Address: Phone: 3. 4. 5. 6. 8. 9. TEMP EVENT APPP&qe 7 at 11 I . I EH01&02 7/28/10 O Other (specify):______—-------—------- Note: The only operations not required to provide enclosed booths TEMPORARY FOOD VENDOR’S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to O Stereo & hotel trays O Steam table & lids . father (specify) <C> Q meats, tamalee, cooked boans, rice. O Camp stove Double steamer Q Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, egg®, and dairy products. ; are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing writ be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. [Seffi'cr (specify); --------------------------- Electricity is provided for my booth’s use: [B'Yes O No I am providing an accurate probe thermometepto measure the hot and cold holding of potentially hazardous foods during all times of booth operation: EJ'Yee No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135T: J UINCt LHKbEN HH1NI1NU iLKVICtC f-HX ND. : 4bbb4b4 the festival coordinator three (3) weeks prior to this event 1.Name of Event: ---------------------------- The following is information about my organization/buslness: Name of orgamzaSo.vbosmess; 777^^ cT/y/V . Address: 97?* J>^- ■ ( <9/Z.) Alternate: ( <?/<*•) ,7/^ ~ .77.^—----------------- P/22.4-. bst food to be sold or given to the public: r ---------------1..........................................— I am providing food that is NOT prepared at home: 0^es □ No AH food is prepared orvsite or is from approved commercial facilities. O’ es O No Name of facility: _________ _______—--------------------------------Phone: (--------L--------------------------------- - Address of facility--------------------------------—------------------------—---------------------- i am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from Kies, dust and the public) fZ^booth with walls and ceHing constructed of either wood, canvas, plastic, similar fereeninq completely enclosing open food areas, ft wiH also have a smooth and cleanabtefloor asphalt^ieSTterps Ld smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. DEC. Ub dM14 HJ