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TEMPORARY FOOD VENDOR’S APPLICATION <br />y'z ^6Date(s):1.I.Name of Event <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potabie water source. <br />{ye.7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7OI11 <br /> Other (specify): <br />Electricity is provided for my booth’s use: 0 Yes O No <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />ETA 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 />Note: The only operations not required to provide enclosed boofhs are those which self 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 />EjApproved bottled water. <br />EHD 16-02 <br />7/20/10 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0Camp stove <br /> Double steamer <br /> Electric stove top <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 />The following is information about my organization/business: <br /> Alternate: ( 3^*) 3> <br />List food to be sold or given to the public: «’ c 5 <br />I am providing food that is NOT prepared at home: 0 Yes Q 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 />Name of organization/business: : ■ <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: I0Yes No