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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. Name of Event: 1. <br />2. <br />Address: <br />(2^' )Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensi* and hand washing wP be provided in my booth by the fo“owing methods:6 <br />[J}-Apnrr>vAd hnttioa wafer <br /> On site hose bib that is connected to a potaWe water source. <br />7 <br />8. <br />9 <br />I am providing a booth with the following: (to protect my unpackaged food and food preparation areas from ffies, <br />dust and the public) <br />0 Other (specify): <br />E*ectricity is provided for my booth’s use- rZ?x'ns Q No <br /> Stemo & hotel trays <br /> Steam tabie & .‘ids <br />O Other (specify) <br /> Camp stove <br /> Doubie steamer <br />O Electric stove top <br />meats, tamales, cooked beans, rice,Note: Examp es of potentia y hazardous food inc ude: <br />vegetables, potato sa ad, eggs, and dairy products <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 />I am providing an accurate probe thermometer to measure the hot and co’d ho’ding of potentia"y hazardous <br />foods during a~ times of booth operation: O No <br />am providing the fo’owing hot temperature contro’ for the hot ho’ding of a" potentia”y hazardous foods above <br />135°F: <br />I am providing food that is NOT prepared at home: No <br />All food is prepared on-site or is from approved commercial facilities: No <br />Name of facility:Phone: {\ <br />Address of facility:. <br /> Alternate: ( <br />e.A/ eXS <br />Name of organization/business: <br />O A booth with wa"s and cei’ing constructed of either wood, canvas, p'astic, simitar materia! and fine mesh fly <br />screening, compiete’y enc'osing open food areas, 't wi“ also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate flood and food preparation <br />areas from the pubic. <br />_ _______________________ <br />Note: The only operations not required to provide enclosed booths are those which se" beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />The following is information about my organization/business: <br />Sjock A-