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TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />3. <br />5 <br />6. <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice, <br />“•je J « 11 TSVP EVENT APR <br />EHO <br /> Camp stove <br /> Double steamer <br />O Electric stove top <br />C 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 />Tte. CTsAm ( Ar dcfi ( <br />Note: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from aporoved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />.^Approved bottled water. <br />Lj On-site hose bib that is connected to a potable water source. <br />□ Other (specify) eL IP A-Sg V\ CA <br />Electricity is provided for my booth’s use: Jj^es No <br />f-ods dunng^l tmesT/bo61 fioT^rj™aSUre hot and cold noWin9 01 potentially hazardous <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ISS’F" <br />-HoT" 0©^ -v <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 />1. Name of Event no? Date(s): ~ C( IxT <br />The following is information about my organization/business: <br />Name of organization/business: HuL, \ <br />Address —t—gx-VtAc) SArrift/A-cxAt: CA- <br />Phone - A O Alternate ( ) <br />List food to be sold or given to the public: SeAA ; , A'.-Ty,,-, &<(■£- <br />I am providing food that is NOT prepared at home jS^-Tes No <br />All food is prepared on-site or is from approved commercial facilities: ElYes No <br />Name of facility; "tTWCi _________ ~ Phone (^1 fc>) 5"?D C <br />Address of facility:'A? EpCA- GrC <br />ancHh"19 fo,loWin9 prolecl my unpackaged fooo and food-preparation areas from flies. <br />3. A 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'2^- ^uM* Srn00th W00d ar# 3ccePtable’ 3nd constructed to separate food and food preparation <br /> Other (specify):