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TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Nsts of Event: <br />7 <br />Nsrre cf o'csnizat'on■ b.;s less: _ <br />Address’ <br />Pncne: <br />3 Lot ‘ccd sc:d or givec ::: ‘!-c ;4 <br />5 <br />■ ! Other ;soec:fy>: <br />5 <br />B'^’P'oved □ott:ed water. <br />i .1 On-site hose Pit that s connected to a petal’ e water source <br />_2’ Other {specify,•: <br />Electricity is provided for my booth's use’ ^Yes C No <br />3 <br />? <br />meats, tamales, cooked beans, rice. <br />5 <br /> Stsmo & -otel fa .3 <br /> Steam table & I'ds <br />_] Other isnecfy: <br />I am providing a booth with the fo'tow.'rg. ;'to p-otect my unpackaged food and food-p-epa-ation areas front flies <br />dust and the public) <br />Apomved water for drinking utensil and na"d was-ing .'. I: be provided in my booth oy tne "o'lowing methods: <br />_j Ca-p stove <br />I... Dcijp'e steamer <br />E-ecrr z stove top <br />Note: Tne only operations rot ’’equired to p'cvic'e enclosed booths a'= those which sell beverages 'rom <br />approved dispense-* or preDackaged foods {’om apcTOved sources <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am c-ovio.ng the fol.owing hot tem.pe-atu-e control for the l-ot holdmg cf all potemiafv haza'dous foods anc.-e <br />135T. <br />SlPt^A booth with .Velis and ce mg constmctea of either wood, carves, plsstic. simrar materia, and :.re mesh ■ y <br />screening completely enclosing open food a-eas. I: wilt also have a smooth and cleanable ’'loor : co cot etc-, <br />asphalt clear, tarps and smooth wood are acceptab’e) and ccnstmcted to sepa'are food and •cod tmeparation <br />areas from the public. <br />I am providing feed that is NOT oreparec at home. C No <br />Ali food s crepared or s te or is '-pm approved co’nmerciai foci ties. ~ Yes Ll No <br />Name crfacTty.Pi.ime ' <br />Address of facility: <br />Ail food vendors (both for profit and non-onyiV are required to return s signed and completed copy of this checklist to <br />the £estwaf co.--di-.ator mi<e7j3; weeks p-ior‘cjthis e ject /Ao / / <br />fhe fol owing is information about m'y-ftmamzation/business <br />LZlrpy h CA-Ur'inA <br />>_...... <br />I am providing an accurate probe thermometer to measure tne -ct and cold -elding o' potentially haza-dcus <br />foods du-ing all: mes of booth ope-aticn: C No