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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Address: <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />8. <br />9. <br />TEMP EVENT APPPage 7 at 11 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />(S'Approved bottled water. <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Alternate: ( <br />Rice <br />i <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 />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 /> 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 />Efother (specify): v J <br />Ca <br />EHD 16-02 <br />11/4/14 <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: Datefs): •'Aeoc yooxol <br /> Other (specify):___ <br />Electricity is provided for my booth’s use: Yes [2^No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes 0 No <br /> Stemo & hotel trays <br /> Steam table & lids /•. <br />Mother (specify) VcdcklAcfc? vO'VUiA H j <br />meats, tamales, cooked beans, rice. <br />■C <1 i <br />). <br />I am providing food that is NOT prepared at home>El Yes No <br />All food is prepared on-site or is from approved commercial facilities: &Yes No <br />Name of facility: Phone: (776) <br />Address of facility: 7 6 6) 9 , Cg, C) <br />r Ci <br />3 4'd <br />The following is information about my organization/business: <br />Name of organization/business: 1 Iv i ' 9 J ' <br />3/6)