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4EMPO RY FOOD VENDORT APPUCATION 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. 1.Name of Event: �r g ry� � eJ Date(s): .1 2. The following is information about my organization/business: Name of organization/business: �lE51-z� /��Xj<fa 1'7_,,;, Address:' 2rc L Phone: ( , C } ' /�- - l S 3 r Alternate: 3. List food to be sold or given to the public: Z'6 --i 5 4. 1 am providing food that is NOT prepared at homer YeDsNo All food is prepared on-site or is from approve commercial facilities: Yes No Name of facility ��.`S�G /1'�E'"GL'a J")r, /1 _ 6,5tQUU"a Phone: 066 Address of facility �&;yc� e/ CIZ&o St, 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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. Other specify):_r,0,4 It/ e jr) C.ZI 1 �GL �3��GC( � L i d i'k I" Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other(specify): ,3 [) S t,Cr -e_r _-,eieCf ri G t 7. Electricity is provided for my booth's use: Yes No 8. 1 am providing an accurate probe thermome to measure the hot and cold holding of potentially hazardous foods during all times of booth operation'Yes No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Sterno&hotel trays Double steamer Steam table&lids Electric stove top Other(specify) Note: Examples of potentially hazardous hood include: meats, Earnales, cooked beans, rice, vegetables, potato salad,eggs, and dairy products. 10. 1 am providing the following cold temperature control for the cold holding of potentially hazardous foods below EHD 16-02