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1.Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />I <br />meats, tamales, cooked beans, rics, <br />Page 7 of 11 TEMP EVENT <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include <br />vegetables, potato salad, eggs, and dairy products. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />hot and cold holding of potentially hazardous <br />*pp <br />Q'Ves No <br />I am providing an accurate probe thermometer to measure the <br />foods during all times of booth operation: Q'Ves No <br />' Pr°viding the Allowing hot temperature control for the hot I aiding of all potentially hazardous foods above <br />135 F: <br />Electricity is provided for my booth’s use: <br />EHD 16-02 <br />7/28/10 <br />The following is information about my organization/business: <br />Name of organization/business: /^'<z <br />06 (/ CO )Cc <br />) 603 7.2,0/ <br />List food to be sold or given to the public: , y. <br />.G' << } ZJ t fcjccy cc c Sy 7^c j <br />Or /Q )S/ r r/cjcrse , c< / <br /> 4 ternate: (7J J ) 32><Lf ' & J 9 \ <br />2 J1, Cc<yj <br />booths are those which sell beverages frcm <br />I sources. <br />Name of facility: 7c//J C' / s <br />Address of facility: ,, 9 C<J Z; / /> <br />-Zr 'Cxz zJ«. c/ Zx^czc/ Co^Ct-O, <br />I am providing a booth with the followingt <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, cJnvas, plastic, similar material and fine mesh |fly <br />screening, completely enclosing open food areas. It will also lave a smooth and cleanable floor (concree, <br />areas fro^^h1 Sm°Oth W0°d are acceptable) and cor stnjcted to separate food and food preparation <br />QOther (specify): /-k / J //,/> 77 ) r J'$ <br />Note: The only operations not required' to provide enclosed <br />approved dispensers, or prepackaged foods from approv >d <br />Approved water for drinking, utensil and hand washing will be pr Mded in my booth by the following methods: <br />QApproved bottled water. <br />Q On-site hose bib that is connected to a potable water source. <br /> Other (specify):__________ <br />i <br />TEMPORARY FOOD VENDOR’ 5 APPLICATION <br />^Lff°05 v®ndor® (b°th f°r Profit and non-profit) are required to return i signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Gr/ <? cz c K(\ C C c z3<Z < x <br />I am providing food that is NOT prepared at home: L_ ?es [3d\l i <br />All food is prepared on-site or is from approved commercial fadl ies: QVes Q No <br />- ------------------------- -------------> - _________Phone: (/t?T ) OS J /Jxj/ <br />____ca <br />Z/CczJcCCzx' *» <br />(to protect my unpack; ged food and food-preparation areas from flies,