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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s) 156r1. Name of Event 1. <br />2. <br />Name of organization/business: Coe; <br />Address;\S~g a & <br />A item ate: Gio-'. ) ^=> —J-Phone: <br />3.jt. <br />4. <br />5. <br />6. <br />R1 Other {specify): 3, <br />NoY< <br />8. <br />S. <br />meats, tamales, cooked beans, rice, <br />TEMP EVEhtTAPPPage 7 of 11 <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />^gj Sterno & hotel trays <br />P<[Steam table & Iris <br /> Other (specify) <br />EHC IG-DZ <br />7/28/10 <br />List food to be so d or given to the public: <br />-® Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />AU food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist tc <br />the festival coordinator three (3) weeks prior to this event. <br />The following is information about my oraanizatiorVbusiness: <br />r~l Other (speci’y): _________________________—— —-----------------— ------ <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 proviced in my booth by tbefoHowing methods: <br />Electricity is provided for my booth s use: <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potent.ally hazardous <br />foods during all times of booth operation:^ Yes No <br />5 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135“F: <br />I am providing food that is NOT prepared at home: ® Yes O No <br />Ail food is prepared on-site oris from approved commercial facilities: Q Yes ZJ No <br />Name of faciity: Uc ---------Phone: - o* <br />Address of facility1: ■'frirra»v-iVc___-..r^—gt.S Yl5!——----------------------------------------------------------— <br />I am providing a booth with the following: (to protect my unpaokaced food and food-preparation areas from flies <br />dust and the public) <br />B7) A booth with walls and ceiling constructed of e ther wooc, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and clearable floor (concrete <br />asphalt, clean taros and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.