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U1/U3HA(dLMAIL BIZ LIC.12/22/2U14 oy: 31 Bibb ri y <br />the festival coordinator three (3) weeks prior to this event <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />1 <br />5. <br /> <br />md haiApproved water for drinking, uh6. <br />ile water source.poi <br />s use:7. <br />th© hot and cold holding of potentially hazardous <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetable, potato salad, eggs, and dairy products. <br />i <br />I am providing a b <br />dust and the pul <br />[fretorno & hotel trays <br />h Ste^rn table & lids <br /> Otherfbpecify) <br />Q Approved bottled water. <br /> On-site hose bib that is connected <br />x <br />I No <br />ride enclosed booths are those which sell beverages from <br />Is from approved sources. <br />washing will be provided in my booth by the following methods: <br />I am providing the following <br />13S’F: <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />signed and completed copy of this checklist to <br />____ Date<s): <br />O A booth with walls ai <br />screening, completely endosihg, <br />asphalt, clean tarps and smooth <br />areas from the public. <br /> Camp stove <br /> Double steamer <br />r~| Electric etova top <br />Note: ExemplM ot potenWl? hazardous food include: <br /> Other (specify);______ <br />Electricity Is provided for my bool <br />I am providing an accurate probe thermometer <br />foods during all times of booth operajlor „ <br />Hing constructed of either wood, canvas, plastic, similar material and fine mes y <br />v open food areas. It will also have a smooth and cleanaWe floor (concrete, <br />■fepod are acceptable) and constructed to separate food and food prepara n <br />AU food vendors (both for profit and non-profit) are required to return a <br />1. Name of Event 6v/ <br />The following is infomnalion about my otganizationfousiness: <br />~f he N <br />7 C) (Np < 6ft. 3 45 h_o <br />^65 4^14 Alternate: ( ——~ ~ r <br />Q Other (specify); --------- - ------—-----3^------ <br />Note: The only operations not required to pi <br />approved dispensers,^r prepackaged <br />r tb^rneasure <br />>n: Yes L^No <br />temperature control for the hot holding of all potentially hazardous foods above <br />Name of organization/business: _ <br />(5)0 )_"* " <br />List food to ba sold or given to the public: <br />I am providing food that is NOT prepared at horned Yes □ No <br />All food is prepared on-stte or is from approved commercial facilities: ® Yes No <br /> <br />Name of facility: — ——a----—jc------ <br />Address of facility: ----- <br />>th with the following: (to protect my unpackaged food and food-preparation areas from flies,