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TEMPORARY FOOD VENDOR'S APPLICATION <br />i <br />2 <br />Address <br />Phone <br />3 j he sold or q.ven t, <br />4 <br />5 <br />Oiher ispeot, <br />6 <br />7 <br />3 <br />aDove7 <br />:tyPF-.-EN‘."age ‘ rf <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers or prepackaged foods trom approved sources <br />tf^amp stove <br />r_J Double steamer <br />Electric stove top <br />Approved water for drinking utensil ano hand washing will be provided in rny bc&ll'i by the fotlowtng methodi <br />^Approved bottled water <br />EHO '<•«: i on 3 ns <br />~ Sterno & hotel trays <br />2p*6team taele & lids <br />"pother (specify' <br />Note. Examples of potentially hazardous food include <br />vegetables, potato salad, eggs, and dairy products <br />I am providing a booth with the following i to protect my unpackaged food and food-pt epar alien areas from flies <br />oust ana the public) <br />^**4 booth with walls and ceiling constructed o! either wood canvas plastic similar material and fir*- mesh fl-, <br />screenma completely enclosing open food areas it will also nave a smooth and cleanable floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable' and constructed to separate ’ood and focd preparatio" <br />areas from the public <br />“ On-site hose bib that is connected to a potabte water source <br />VSine. (Spe^ 3^- ■_________ <br />Electricity is provided for my booth s use Yes ^No <br />lometer to^measure the hot and cold noiding of potentially hazardous <br />K Yes i_J No <br />'t'ri4ct(A\ <br />All food vendors i both for profit and non-profit i are required to return a signed arid completed copy of\iis checklist to ] ] <br />the festival coordinator ttaeepi weeks poor to this event / J <br />Name of Event 33^ pateis/M^- iu <br />The following is information about r^i^gjln)<*ffij?nibj/5ine^ > <br />Name of organizationibtisiness <br />yiAW; SToct^ .Qa <br />Alternate i, <br />l.s, 1000,0 be sold o. yven ,o the pub,,- MF <br />I am providing food that >s NOT prepared at home J<j»Yes[ J No » <br />All food is prepared on-site or is from approved commercial facilities &Yes H No <br />Name of facility Phone t i_ <br />Address of tacilrtx _ <br />I am providing an accurate probe therm, <br />foods during all times of booth operation <br />i am providing the following hot temperature control for the hot holding of all potentially hazardous foods <br />t35'F <br />m«»at«s ronkert heans. rice.