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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.Name of Event: <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />7. <br />8. <br />meats, tamates, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />EHD 16-02 <br />10/13/09 <br />O Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Q Camp stove <br /> Double steamer <br /> Electric stove top <br />dust aJJdme public^ fOllOWin9; (to protect my “"Packaged food and food-preparation areas from flies, <br />YA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />-screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />area^frouLfoe pubficarld Snl00th W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify):____________ <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 />pragj n <br />The following is information about my organization/business: <br />Name of organization/business: k+fkTopi <br />swyfa ciwa HgivjiAjard, 01-9^4^ <br />< 50 ) Aitemate: ( 4________ <br />corh __________ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Jj^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />1 am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: An-sric _______Phone: £) <br />Address of facility:____ ________________________________ <br />Electricity is provided for my booth’s use:jgj Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation: Yes^S No H-1 Cj <br />lam providing the following hot temperature controi for the hot holding of all potentially hazardous foods above <br />13o r'