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1. <br />2. <br />3.Address: <br />(5^) Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />rd4/ <br />5. <br />6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEW EVENT APPP«g«7crf11EHO 1S-02 <br />08/01/16 <br /> Camp stove <br />O Double steamer <br />O Electric stove top <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Fl Stemo & hotel trays <br />O Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): — .........—. <br />Elecfricity is provided for my booth’s use: Yes 0No <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 />AKanate: ) ^ 5 - <br />- <br />I am providing food that is NOT prepared at home: 0Yes No .... <br />Ail food is prepared on-site or is from approved commercial facilities: Ej Yes QlMo <br />Name of facility: We:*>7~ __Phone: (--------) —----------------— <br />Address of facility:*^7^7 — ------------------ <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 />Ba" booth with waifs 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 />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 /> <br />t.Name of Event:-Date(s): jLHUI------ <br />The following is information about my organization/busin^s: <br />Name of organizationfousiness: <br />A/ £>£-/'