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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2 <br />AddiHss. <br />Phone. <br />3 <br />4 <br />5. <br />6 <br />[ 1 On-site busfc bit* that is connected h> a pnlable water source <br />□ Other (spectly). . <br />7 <br />& <br />9 <br />6* i [ | <br />meals, tameRes, cooked beans, rbcv, <br /> Olher (specify)............................ <br />Note: I he only operaiiar® not required to provide cnctofied booths aic IhOSO which sell beverages from <br />approved dispensers, or ptepackaged toOdS from approved suuiCCS <br />Appiowd water for drinking, utOdSH and hand washing will De provided in my booth by the following methods <br />□-Approved bowled waler. <br />Dale(ft)*5 .. <br />rrtamp stove tTsternc? & hotel trays <br />D Double steamer ID -Steam table & lids <br /> Flfsctric stove lop ET Olher (specify) pj 1ft <br />Naic; Examples of potentially hazardous food Include: <br />vagetabtes, potato salad, eggs, and dairy products. <br />LteOtncity is provided lui illy booths use. d Yes [uJ'ISIo <br />I am providing an accurate probe therniamet^-te meosiire the hot ar*d OOH holding ul pOteht ally hazardous <br />luuefe during all trues d booth operalion. ET Y'es |_| No <br />I am providing the fcllawmg hot temperalure control for the hot twirling of all potentially Iwarrinus foods atoave <br />135T- <br />I am prOVidmg a booth with Itw IciHowtng' (tn prated my unpeckaged food and loud preparation areas Irorn dies, <br />dust and .the public} <br />Up A booth wilt* walls and ceiling constructed ul e4her wnori camvas. plastic, similar material and fine mesh fly <br />screening, aomplelely enclcsmg open food areas. It will also have a smooth ar»d cleanable floor (concrete, <br />asphalt, olean tarps and smooth wood are acceptable) and cccistructed to separate food and food preparation <br />areas from the public <br />The following irTformatim ebniri my wganizatlionlbiisiness-. <br />X •-’» 1 : O. ZName of txganizaborubusiness' t, jC<L< F ■'L .1 <br /> C-/C_ <br />I & C-Alternate-( << <br />List food to be suM or given Io the public. 1 VS i <br />All food vendors (bolFi for proffl and non-profit) are required io return a signed and completed copy of this checklist to <br />the festival ooordinalor three (3) weeks pnor fa this event. <br />I.Narrte of Fvenr j <br />I am providing food that is NOT prepared Of home- E7j No <br />AT food e picparod on-site or is frern approved commercial facilities. S^fesTJ NoName of facility. Fhune’{-------------------------------------------------------------------- <br />Address of facility. .