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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />4,'9/12 <br /> Camp stove <br />0 Double steamer <br />S. Electric stove top <br /> Other (specify):________________________ _____ <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Electricity is provided for my booth's use: H^YesD No <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Al 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 />I.Name of Event: C Date(s): <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br /> Sterno & hotel trays <br />0 Steam table & lids <br />0 Other (specify) <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 />"KLa 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 />The following is information about my organization/business: <br />Name of organization/business: <br />Address: | OD\h CQSVl C |<4ZV)'| <br />curi) (f^ Aternate: ( ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: [^Yes No <br />Al food is prepared on-site or is from approved commercial facilities: <br />N ame of facil ity: ___ <br />Address of facility:_ <br />I am providing an accurate probe thermomete^to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Bves No <br />YesO No <br />Phone: ()