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TEMPORARY FOOD VENDOR’S APPLICATION 1. Name of Event:1. 2. Phone: List food to be sold or given to the public: 3. 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. On-site hose bib that is connected to a potable water source. Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, Page 7 of 11 TEMP EVENT APP / Vctrfcs MV. <^2-^ EHD 16-02 7/14/15 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. I am providing an accurate probe thermometi foods during all times of booth operation: 0 0 Sterno & hotel trays 0 Steam table & lids Other (specify) =rfo measure the hot and cold holding of potentially hazardous Yes 0 No S Qx feral Q 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. Electricity is provided for my booth’s use: 0Yes 0 No Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. J0 Approved bottled water. ^00 ...................... I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135T: 0 Camp stove 0 Double steamer 0 Electric stove top 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___Date(s): fT"1 ) 2-Q)^^VkrAM ‘in The following is information about my organization/business: Name of organization/business: C Address: 2-3D \4. , (2^^) ~ Alternate: ( ) 333 ~~ ______________________ I am providing food that is NOT prepared at home: 0Yes 0 No All food is prepared on-site or is from approved commercial facilities: 0Yes 0 No Name of facility: I Phone: ( QO Address of facility: ZX? 8 O lx-£fevl eJH I——[ CzA". I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public)