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TEMPORARY FOOD VENDOR’S APPLICATION required to return a signed and completed copy of this checklist to 1. 2. Address: Phone: 3.List food to be sold or given to the public: 4. 5. Other (specify): 6. On-site hose bib that is connected to a potable water source. 7. 8. 9. meats, tamales, cooked beans, rice, EHD 16-02 Pane 7 of 11 TCMD CX/CMT Ann Other (specify): Electricity is provided for my booth’s use: [vfYes No Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: [^Approved bottled water. Camp stove Double steamer 2.^-?)' KI Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 0"Yes No Date(s): All food vendors (both for profit and non-profit) are r ' ' ‘ the festival coordinator three (3) weeks prior to this event. I.Name of Event: Z76 frhi IdW /'/as&//&/ The following is information about my organization/business: Name of organization/business: d/^/a/ea? 010/5 y^1^/33 __ Alternate: 3b>5- bl l/Lq /Ph \ u1/rf op, / bro 075, I am providing food that is NOT prepared at home: H^Yes No All food is prepared on-site or is from approved commercial facilities: [HYes No Name of facility: bi701 ^0/detr) begiOQ) Phone: (^Q) 3^^- / Address of facility:^P' hs-P boc/o / <2^/0 I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ' \ OcMyuV w^-r-A- A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public.