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HBHI <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2 <br />3 <br />4 <br />5 <br />are tnose which sell beverages from <br />6 <br />3. <br />9 <br />■ <br />O Stemo & hotel trays <br /> Steam table & lids <br />O Other (specify) <br />Note: Examples of potentially hazardous <br />■ <br />■" <br />| <br />I ■IAll 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 />< Name of Event (J Date(s). <br />The fol owing is information about my organizationZousiness: <br />Name ta orgaizsMonAxniness: <br />A<3dreSS <br />P****- IZQ&yfte_______________ Alternate: <br />List food to be sold or given to the public g/’- ZZerAz* <br />I am providing food that is NOT prepared at home: Jg) Yes 0 No <br />Ail food is prepared on-site or is from approved commercial facilities: Yes O No <br />Name of facility: ______________________Phone, ( }L________ <br />Address of facitty:_ ____________________________ <br />’ dusT^?the pubtfo)1 <Wlowin9: (to protect my ur<3acka9ed food and food-preparation areas from flies. <br /> A booth with walls and ceifing constructed of e ‘-er wood, canvas plastic, s.milar material and fine mesh flv <br />screening completely enclosing open food areas It w. also nave a smooth ano cleanable floor (concrete <br />?eas fron^lhe p ^and Sm0°th WOOd 3re acceptabfe> ar?d «>ns;fructec to separate food and food preparation <br />O Other (specify ; <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for dnnkmg, utensil and hand washing will oe prouder: m my booth by the followmg methods: <br />XI Approved bottled water <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify).' <br />Electricity is provided for my booth's use: Yes^hlo <br />1 h0‘and ,:ola h°ldl"9 <br />I am Piding the hot temperature control tor the hot holdmg of alt potentially hazardous foods above <br />■Scamp stov^z^Tf?Q <br />O Double steamer <br />LJ Electric stove top <br />vegetables, potato salad.'eggs. and dliiXJuc^ mea,S’ ta"’a'eS' COOked beans' rtre' <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT