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TEMPORARY FOOD VENDOR’S APPLICATION <br />rooty1. Name of Event: 1. <br />2. <br />Address: <br />Alternate: () Phone: <br />3 <br />4. <br />1 <br />5. <br /> Other (specify): <br />6. <br /> Approved bottled water. <br /> On-site hose bib that is <br />O Other (specify)^ <br />Electricity is providei7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing an accu <br />foods during all times <br />Note: Examples of potentially <br />vegetables, potato salad, i <br />EHD 16-02 <br />11/4/14 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />nnected to a potatje water fcoorce. <br />\__1 \ ________ <br />r my booth's use: Ves S-*fo <br />Tate probe thermometer to measure the hot and cold holding of potentially hazardous <br />oftbooth operation: Yes No <br />----------------------------------------------------- <br />I am providing a booth with the npllowing: (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 />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home:/E^Yes □ No . <br />All food is prepared on-site or is from approved commercial facilities: Ye^ZJ No <br />Name of facility:Phone: ( <br />Address of facility: <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 />Date(s): <br />--------------------------------------------------- <br />Note: The only operations not required tb provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepaqkagetrfqgdsjpdm approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Name of organization/business:. <br />> 2 7, <br /> Star no & hotel trays <br />□ Steata table & lids A <br /> Dther (^oecify) 1 <br />hazardous FOtSd include: <br />eggs, and dairy products. <br />The following is information about my organization/business: <br />y¥\Cn\ co A