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03-07-19;04:29PM;#2/7 3. 4, 5. 6, 7. 8. 11 aVBNT APPCMDlMn ion mw P^OO is UAPcl T& r\Q/)F~e maatB, tamalM, cookad baanv, rlca, 7. - ISFF: /'□ Campatova 'U Double atnamsr Electric atove top Stemo 4 hotel trays Steam table & ads ,■ Other (specify) Note; Examples of potentially hazardous food Include: vegetables, potato salad, eggs, and dairy products. TEMPORARY FOOD VENDOR’S APPLICATION AH food vendors (both for profit and non-profit) ere required to return a signed and completed copy of,this checklist to the festival coordinator three (3) weeks prior to this event 1.^ NameofEvent-____________ nar«(«); S/'ISk ~ /O U //? ' \. I' lh / / Cl 1 The following It Information ebout my organlzaUon/bvsIntM: -/ ' ' I ' ‘ , i Naneof oroantzstton/business: L-Qg-o OF T^e. l—L-C, I- Address: Sr-zj^irj^. p6<Nl~r Wav k____________ : Phone: (ZO^) Alternate^ ) Ust food to be sold or given to the public: P C-H-i FEENOrt FC-tE S, I am providing food that is NOT prepared at home: {§, Yea No All food la prepared on-site or Is from approved commercial facilities: JKJ Yes No Name of facility: CJdAFfoKNlft LATeK.IN6 Tfi.0d<. Phone: (^ Addreta offadlltv:_'^2.D S Aufog-N .ft St . ^rtorM.r-fThtJ /^A. I am providing a booth with the fosowing; (to protect my unpackaged food and fbod-preperatlon areas from Hee dust and the public) ’ A booth with walls and ceiBng constructed of either wood, canvas, plastic, similar material and fine mash fty screening, completely enclcelng open food areas, It will also have a smooth and cleanable floor (concrete, asphalt, dean tarps end smooth wood are acceptable) and constructed to separate food and food preparation Brass ■from tfi® public. ■\ ' vt) Other (specify): FOCO TgAlL Noto: The only operations not required to provide enclosed booths are thdsa\ which sell beverages from approved dispensers, or prepackaged foods from approved sources. —- I Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-dte hoee bib that Is connected to a potable water source. Ji Other (specify): tuteg-CiA L S<nJK_______ Electricity Is provided for my booth's use; J0 Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hffiardous foods during all times of booth operation:^ Yes No I am providing the followtna hoi temperature control for the hot holding of all potentiaUy hazardous foods above