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TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three (3) weeks prior to this event. <br />Date(s): I.Name of Event: 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />9. <br />mute, temalas, cooked bean», rice. <br />TEMP EVENT APPPage Toril <br />Scanned with CamScanner <br />EH01MJ2 <br />00/19/19 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> Date(s):^ <br />7. <br />8. <br />Motel Exawi <br /> Other (specify): ---------------------------------------------------------------- -------- --------- <br />Note: I he only operations not requited to provide nnrJORed booths era those whloh eell beverages from <br />appiuvud ditrpcrram, or phJpinAuqvd (butte from irpjruwU suutwj. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />IT] Approved bottled water. <br /> On-site hose bib that Is connected to a potable water source. <br /> ______p®*— ---------------------------------——■— <br />Electricity is provided for my booth's use: U Yes 21 No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />- .................................... “mtJZfYesQNo <br />ihlrocontrol for the hot holding of all potentially hazardous foods abovefoods during all times of booth operation: <br />I am providing the following hot temperate <br />135*F' <br /> Camp stove ^0 St®™ * <br /> Double steamer Steam table & lids <br />O Electric stove top Other <br />_______ ot potenilaU^ haxaixtouc food. Include: <br />vegetables, potato salad, eggs, and dairy products. <br />The following Is Information about my organlzatlon/buslness: <br />NameolorQanlzaUonfousiness: __________________ __ _________ <br />W UAvol-hn or- 5WW <br /> Alternate: ( ) ________ ________— <br />List food to be sold or fllv.n to the public: QWSflWOSj 1A X)\'(V\A ¥& l^t) <br />I am providing food that Is NOI prepared at home^Yes O No <br />All food is prepared on-site or Is from approved commercial facllitiesj^J Yes No <br />Name of facility: ____________ - Phone: 1 1__________— <br />Address of facility: ____________ _______________________——----------------------—---- <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 />J2a booth with walls and celling constructed of either wood, canvas, plastic, similar materia! 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.