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Ik <br />required to return a signed and completed copy of this checklist to <br />2. <br /><7 <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 rEMP EVENT APP <br />use: QVes No <br />A t -e b <br />foods during all times of booth operation:JzK'es No <br />1 Pr°viding the snowing hot temperature control for the hot holding of all potentially hazardous foods above <br />1 Ou r". <br />rye <br />EHD 16-02 <br />7'28/10 <br />List food to be sold or given to the public: I <br />canvas, plastic, similar material and fine mesh fly <br />■2 .u.2-,2 a smooth and cleanable floor (concrete, <br />acceptable) and constructed to separate food and food preparation <br />------ , \ SA G Putr <br />are those which sell beverages from <br /> Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are r _n_:.. ’' <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1. Name of Event: V Cl V V Q V b ______ <br />The following is information about my organization/business: <br />Name of organization/business: T fl 7_C>Vo " <br />Address: I Cj V/<2Sb <br />1 T P.r°VLdi£9 3 W'th the followin9: (t0 Protect my unpackaged food and food-preparation areas from flies <br />oust and the public) ’ <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />sspnait, clean tarps and smooth wood are -----±> . , . <br />areas from the public. ■ <br />JZbther(specify): dUa C LlWvSn} P <br />Note: The only operations not required to provide enclosed booths c" <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 />-J/fApproved 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 <br />1 ?r°HVidin9 a? accurate Probe thermometer to measure the hot and cold holding of potentially hazardous <br />Date(s): | \ <br /> Alternate: ( ) _ <br />J pap I Choice n <br />I am providing food that is NOT prepared at home: Yes £2^0 <br />All food is prepared on-site or is from approved commercial facilities: ^Yes No <br />Name of facility: ____________________________ Phone: ( ) <br />Address of facility: