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TEMPORARY FOOD VENDOR’S APPLICATION <br />Axva KJk, Lvh1. <br />2 <br />..^3.3ull*^7Address:kx <br />^7 2^ - 4 ‘/'2-5~Phone:(201 )) <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 />Page 7 of 11 TEMP EVENT APP <br />Name of organization/business: <br />3ol ft>n <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />__________ Alternate: ( <br />Om d Te.i' - I i'q <br />RHD 10-02 <br />7/14/15 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: LxHyjujy <br />The following is information about my organization/business: <br />’x Shoo k-fn <br />Z-Arv8’______bn <br />I am providing food that is NOT prepared at home: ij^Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility. crf= Phone: <br />Address of facility. Tiya TtUHje. (^-n+iUJiO 64.. <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />0 A 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 />areas from the public. <br /> Other (specify):__________________________________________ <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 /> Yes 0. No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F <br /> On-site hose bib that is connected to a potable water source. <br />£3 Other (specify): J-C^ )ao <br />Electricity is provided for my booth's use: <br /> Sterno & hotel trays <br /> Steam table & lids <br />@~Other (specify) C.AWvl(Mo <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Date(s):