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1. <br />2. <br />Phone: <br />3. <br />4 <br />5. <br />6. <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />EHD 16-02 <br />10/13/09 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />^ted t0 re,urn 3 Si9ned and Comple,ed copy °f ,h's checklist to <br /> Name of Event: Date(s): <br />The following is information about myorganization/business: <br />Name of organization/business. <br />Address: <br /> Alternate: ( )_____________________ <br />List food to be sold or given to the public. ///kJPZ) <br />, / A. ______-------------- <br />I 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: __________ Phone: ( ) <br />Address of facility:__ <br />dust andVthenpuabfc)Oth f0"0Win9: (l° protect my unPackaged food and food-preparation areas from flies, <br />5r^nv>?,th Wth ?T"iS and ,Ceil'n9 constructed of ei,her wood, canvas, plastic, similar material and fine mesh fly <br />screen ng completely enclosing open food areas It will also have a smooth and cleanable floor (concretey <br />arfa. and srn00,h wood are acceptable) and constructed to separate food and food preparation <br />areas Trom in© puDUC. <br />□ Other (specify):/'TlZ. Pz-p/jJ <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 />Approved bottled water. <br />E^On-site hose bib that is connected to a potable water source. <br /> Other (specify):___________________ <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes No A? poienuauy nazaroous <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />/V <br /> Camp stove [j Stemo & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.