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985123-2 TEMPORARY FOOD VENDOR’S APPLICATION Date(s): 01/16-01/18/2015Lodi Home and Garden Show1. Name of Event:1. 2. Address: ( 352 ) 483-7600 ex5Q8 ) Alternate: (Phone: 3. 4. 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APRPage 7 of 11EHD 16-02 7/28/10 Camp stove Double steamer ^^Electric stove top Approved bottled water. Sfbn-site hose bib that is connected to a potable water source. Name of organization/business: 4129 United Ave, Mt Dora, FL 32757 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) The following is information about my organization/business: Lustre Craft Electricity is provided for my booth's use: S^Yes No Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: 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 List food to be sold or given to the public: less than 1oz free sample of chicken and mixed vegetables I am providing food that is NOT prepared at home:'^Yes No All food is prepared on-site or is from approved commercial facilities: Name of facility: in booth on site Address of facility: :l^Yes □ No Phone: ( ) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. pother (specify): indoor booth