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5 TEMPORARY FOOD VENDOR’S APPLICATION 1. 2. Address: ( 5^^ tMI Alternate: (). Phone: List food to be sold or given to the public: 3. EZVes4. 5. C^Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. "S^-Approved bottled water. Other (specify): 7.Electricity is provided for my booth's use:Yes 8. Page 7 of 12 TEMP EVENT APP A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: NoQ I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) r LzA ) , C4 I am providing food that is NOT prepared at homeS- All food is prepared on-site or is from approved commercial facilities: ------------------------------------------------ Name of facility: Address of facility: .0^ On-site hose bib that is connected to a potable water source. EHD 16-02 7/14/15 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. No All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1. Name of Event: Date(s): ------- ------ •8'4T)|aio)(z) The following is information about my organization/business: Name of organization/business: Ida No Cl Yes No Phone: ()