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TEMPORARY FOOD VENDOR'S APPLICATION <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. 1.Name of Event: ftkk-1jjjn <br /> ��� di j(:,6 Date(s): <br /> 2. The following is information about my organization/business: _ <br /> Name of organization/business: <br /> Address: =� "(d✓ �dLC-i=L/ Z) <br /> Phone: �f'�/ ) f7 6 Alternate: (dL ) <br /> 3. List food to be sold or given to the public: /7 C �7l'� _'Cv F'BUT <br /> 4. 1 am providing food that is NOT prepared at home: ❑Yes ❑ No <br /> All food is prepared�f site or i lfrom approved commercial facilities: E]Yes ❑ No <br /> Name of facility: ►�G�2 �S Ip 6��P �JiQ Phone: Z-P <br /> Address of facility: 2 Z c7 C-Cl 6c ye 7-1�­ L/ <br /> z <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> �ooth 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 (99ncp9e, <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 /> 6. Approv d water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> 0 Other(specify): J�yl(t C..� -yl- r a 111-vl ���� �/2 o <br /> 7. Electricity is provided for my booth's use: ❑ Yes ❑ No <br /> 8. 1 am providing an accurate probe thermomete fo measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> EJ-Gump stove ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table &lids <br /> ❑ Electric stove top [i 'Other(specify) A& <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 08/01/16 <br />