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TEMPORARY FOOD VENDOR’S APPLICATION <br />of c'/ent:Date;;; <br />Address: <br />Phene: <br />3 L.st ‘ccd te re so:d or given to ‘!'e pub o. <br /> Other ;scec:fy): <br />5 <br />3 Aporoved bottied v?ater. <br />1 On-site hose bib that s connected to a potab e .vater source <br />; Other ■spec.fy/' <br />Elect'o.t; is provided for my booth's use' tLYes C No <br />3 us <br />a <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: Tne or'y operations rot -equ.reo to p'cvio'e enclosed booths are those when sell beve-ages •'om <br />approved cispense's or p'ebackaged foods ‘-xi approved sources <br />~i Ca—p stove <br />Doub’e steamer <br />3 E e-- o stove too <br />g^Sterno & hotel trays <br /> Steam tab's S I ds <br />n Otner tspec-y) <br />I am prov ding a booth with the 'b lowing :;o protect my unpack aged food and foou prepaiation areas 'rom flies <br />dust and the public) <br />I am prcvdmg food that is NOT oreoa'ec c-t none as No <br />AH food ;s brepared or s te or is f'om "pproved commercial foci’ ties ~ Yes Q <br />Name cf facrity. Ph:.-= <br />Address of facility: <br />I am p-o.-ie ng the following Imt temoe-atu'e control for the ~ot hold -p -f all potentia'N haza-dous foods abc . e <br />135T. <br />Apo'oved wafer for drinking, utens/ and na-.d was-ir.g wll be provided in my bootn oy tne ''oilov.mg metnods <br />I am providing an accurate erode thermometer to measure tne not and cola t-oluirg o' potentially baza-, <br />foods du-ing all times of booth, cpemticn.Yes 3 No <br />A boot'r with walis and ce "g constmcied of either wood, canvas, plastic, simrar maters; and f re mesh ' y <br />screening completely enclosing open food areas It .wll also have a smooth arc cleanable flocr tconcrete, <br />asphalt clear, tarps and smooth wood are acceptable) and oonst'ucted to sepamte food and food preparation <br />areas from the public. <br />meats, tamales, cooked beans, rice. <br />Ail food vendors (both to:' profit and non-profit) are required to return a signed and completed copy of this checklist to <br />•!~= 'estival co-'di-.ator tl-r-^3; wee-rs Zim ‘p th s evert ZYn <br />liSlo _ <br />The fn' owing is irYc-mation ebot.t my oioamzation.-'businesf I I <br />^ee:,=Sn63:::,C..5n2ss H<W)/S <br />4Y) .w. U W <br />bC1^ '3'7 r> - C/A-Q . ,__ <br />