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ACE LITHO209478114:9112/18/2014 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):1. <br />2. <br />Address; <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice,Note: Examplee of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMP EVENT APPfSqe ? of 11 <br />II <br />EHD 10-02 <br />7/2W10 <br />O Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br />EJSteam table & lids <br /> Other (specify) <br />Electricity is provided for my booth’s use: 0xYes No <br />I am providing an accurate probe thermometer to measi <br />foods during all times of booth operation: 0 Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F; <br />measure the hot and cold holding of potentially hazardous <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 />1 Name of Event: 4 Date(s): '/'O- <br />The following is information about my organization/business: <br />Name of organization/business: <br /> Alternate: ( )------------ <br />List food to be sold or given to the public: _ <br />I am providing food that is NOT prepared at home: Q Yes 01no <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility:______ <br />Address of facility:_— <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 /> 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> 0^Other (specify): u/-------------------------------------------------------------------------—--------- <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />^Approved bottled water. <br />(3$n-site hose bib that is connected to a potable water source. <br />PAGE 02/03 <br />3res No <br />Phone: (1