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TEMPORARY FOOD VENDOR’S APPLICATION 1. 2. Address: Phone: 3. 4. 5. 6. I am providing an accurate probe tiiermoi8. 9. Note: I TEN(f> EVENT APPPage 7 of 11 saawwns EHD 16-02 7/2W10 meats, tamales, cooked beans, rice, Camp stove nSfemoA hotel trays Double steamer D Steam table & lids Electric stove top pother (specify) i C Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. 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. t.Name of Events D3te(s): 10-20^ The following Is Information about my otganization/business: Name of organization/buslness; ------------- •^0 t 6004231- CJr ( 2.^) Alternate:(2/^) List food to be sold or given to the public: tx&PTV*- \ Z0/T0 39Vd e3ESZZQ60Z WdQQJEQ t>l0Z/TT/S0 I am providing food that Is NOT prepared at home: C8 Yes No Ail food is preparetf^^je^r Is from approved commercial facilities; Yes O No Nome of facility: N j __Phone:.(_.. J.------------------------ ---------—------ Address of facility:_— ..................... .................. .......— I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from tiies, dust and the public) to 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 cleaneble floor (concrete, asphalt, Clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify):.-——" Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: JSj^pproved bottled water. On-site hose bib that is connected Io a potable water source. Other (specify):.........—-------------------------—— ------------------- 7, Electricity is provided for my booth’s use: Yes $MNo am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: J^Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135T: