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A <br />'1/1 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.Date(s): <br />2. <br />Address: <br />Phone: <br />F <73. <br />5 <br />6 <br />7. <br />8 <br />7. <br />meats, tamales, cooked beans, rice, <br />P»ge 7 of 11 TEMP EVENT APPEHD lft-02 <br />10/13/C9 <br /> Stemo & hotel trays <br />C Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am provldim <br />135T: , ’ <br />E^Yes No <br />I am providing an accurate prooe thermomi <br />foods during all times of booth operation: Qj" <br />Electricity is provided for my booth’s use: <br />A booth with walls and ceiling constructed of either wood, canvas, plastic, simitar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />a^eaTfronTthe'p Srn00th 'W30d are accePlable> and constructed to separate food and food preparation <br />C Other (specify). <br />^ef to_measure the hot and cold holding of potentially hazardous <br />dust and^he pubfc)Ot>1 ,OllOW,n9' fl° protect ^packaged food and food-preparation areas from flies, <br />f°ll0wins hot temP®rature control for the hot holding of all potentially hazardous foods above <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />t0 retUm a S'9ned and “mple,ea of this checklist to <br />Name of Event: $_________________Date(s). j21. - <br />The following is information about my orgamzation/business <br />Name of organizatiorVbustness: T/T? \, ^ T'T'L^ C-- ^-/kJ <br />([) S:Hfi/LT'/di ^/\J <br /> Alternate: ( f/O) C <br />List food to be sold or given to the public. ^^'7'7’1 CoX-aJL QC>t <br />I am providing food that is NOT prepared at home: Efves No <br />All food is prepared on-site or is from approved commercial facilities Yes [H No <br />Name of facility: phone. ___ <br />Address of facility: <br />Note: The only operations not reouired 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 />E^Approved bottled water <br /> On-site hose bib that is connected to a potable water source <br /> Other (specify) ___________ ______________________