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i EMPORARY FOOD VENDOR/S APPLICATION <br />i.Date(s): <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />6-02 Page 7 of 11 TEMP B/ENT APPEHD <br />8/1/V <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />rkj-^ferno & hotel trays <br /> Steam table & lids <br />{^g^ier (specify') <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />are those which sell beverages from <br />lo <br />iilities.^ Yes No <br />——.——_____________*______;______Phone: £ <br />^^4,^ AJ ___________________ <br />1 ^sTand the p bb|Ot)h f°llowin9: (t° Protect my unpackaged food and food-preparation areas from flies, <br />ityA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material 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 /> Other (specify):________ ______________________ <br />to |measure the hot and cold holding of potentially hazardous <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />thf festal coordinator three (3) weeks pto to S S*"’" * Sl9ned “d “Py °' "* tT5' <br />I.Name of Event: 0/5//^ <br /> On-site hose bib that is connectedto a potable water source. <br />^Zther (specify): (jjPfc P | Y\ I <br />Electricity is provided for my booth’s use: Yes No <br />I am providing an accurate probe thermomei <br />foods during all times of booth operation: <br />I he rollowing is information about my organization/business: <br />Name of organization/business: <br />( Alternate: ( ) <br />A, P^T^L/k <br />I am providing food that is NOT prepared at homeXO'/es^Qt <br />All food is prepared on-site or is from approved commercial Tacili <br />Name of facility: "5_________ <br />Address of facility:. <br />All food vendors (both for profit and non-profit)