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'Tfr/r) <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7 <br />8.the hot and cold holding of potentially hazardous <br />9. <br />food include:meats, tamales, cooked beans, rice, <br />£H0 16-02 P>’!je 7 of 11iio;-, c rEMF EVEHTAPP <br />Date(s): ////^ <br />a signed and completed copy of this checklist to <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this event. <br />1. 1. Name of Event: 7^) <br />The following is information about my organization/business: <br />Name of organization/business: d j <br />S|. <br />(2^9 )_^4 Alternated ) <br />List food to be sold or given to the public: .10 (C ± n l< /(\ I - <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: -------------- ------------------------- ---------------------------- phone: { <br />Address of facility: <br />—fgbflA llj ^-zay a irt ff'' <br />_________ Alternate: ( <br />' ^sTa^d the pub^ f0"°Win9: Unpackaged food and food-preparation areas from flies, <br />areas■ fromthepXc aCCeptab,e) and constructed to separate food and food pJeparation <br /><0 Other (specify): Ll/utWry, ____________ _ _________________ <br />Note: The only operations not required to provide enclosed booths are those which sell beveraoes from <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 />-^EfApproved 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 use’^fYes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation :^JYes O No <br />1 follow hot temperature control for the hot holding of all potentially hazardous foods above <br />Q Camp stove Q Sterno & hotel trays <br /> Double steamer steam table & lids <br />^Electric stove top other (specify) <br />Note: Examples of potentially hazardous f„J <br />vegetables, potato salad, eggs, and dairy products.