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TEMPORARY FOOD VENDOR’S APPLICATION & I .Name of Event: 1. The following is information about my organization/business.2 Address: Phone: List food to be sold or given to the public: 3. 4. No Aioq-cnoi 5. 6. On-site hose bib that is connected to a potable water source. Other (specify): 7. to measure the hot and cold holding of potentially hazardous8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APRPage 7 of 11EHD 16-02 11/4/14 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: [vfApproved bottled water. 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. Q^ther (specify):______________________________________________________________ I am providing the following hot for the hot holdir,g of 3,1 potentially hazardous foods above Camp stove Sterno & hotel trays Double steamer Steam table & lids Electric stove top Other (specify) Electricity is provided for my booth's use: Yes [y^No 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. O TV Date(s): Q I am providing an accurate probe thermometer to measi foods during all times of booth operation: M Yes No Name of organization/business: Q Q OO-dX V-Q — po BOX (/AlUj) ___ Alternate: ( ) I am providing food that is NOT prepared at home: [vfYes No All food is prepared on-site or is from approved commercial facilities: H^Yes Name of facility: (3 Av T V/Cl/- Phone Address of facility: H SO RUX