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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profs and non-protif)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)Creeks prior to this event <br /> 1. 1.Narre of l_vmnt 5 Va�T� `Tf(:� Vt-V' 5 � � Date(s}: S <br /> 2. The fol!owin g is infor retior at4o�, my arg niz�ttiusinass: /�� /�� r'N P{-e <br /> Name ci arganizatvilb rsiiness: _Q0- <br /> Address: �1Q.� 1h1• /M��(!J�`�C► <br /> Phone: ,'ZJ�? ._ .! Aite.*Hate:E <br /> w l.ss!`003 da be 5c:d or given to itta¢awE6c: �GAr oc, <br /> E. 1 an, providing food that is NOT prepared at tome:n yes No <br /> AA food is prepared or-site or is from approved cornmercial facilities:1Yes No <br /> Name of fac ffty; _ qv Phone f f <br /> Address of fedity:�iJ�--�j - <br /> 5. I am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from Mies, <br /> Must and the public) <br /> booth With toads and ceiling constructed of'eitter wood, c»as,plastic, sirniiar material and fine mesh i y <br /> eerling; completely enclosing open food areas. It will also tt-ave a smooth and cleanabia floor (concrete, <br /> sphalt,cyan tarps and smooth wood are acceptable) and consttvctad to separate food and food preparation <br /> areas from Pie public. <br /> Cl other(specify): <br /> Note: The only operations not required to pro,0de enclosed t_-=hs as those which sell beverages torn <br /> approved, dispensers,or prepackaged foods from approved sources. <br /> S. Approved water for drinking,utensil and hand washing will be provided in my booth by the 11bilowing methods: <br /> (( Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> --1 Other(spe*): <br /> 7. Elactrick,is provided for my booth's use Yes❑ No <br /> 8. 1 an, providing an accurate probe tfermorneter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation Yes C!No <br /> g. 1 am providing the foilowing hot temperature control for the ;not holding of all potentia!ly hazardous foods a'oove <br /> 135°P. <br /> Camp stove C1 Sterno&hotel trays <br /> I�ZDouNe stearrer Steam*.able&Udss <br /> E-lectric stove top - tither(sway) 1,, C'e - <br /> Note: Examples of potentially hazardous food include: meats, tama!es, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> Emild ISIU Pwp i of 1; iEw EvENT$1=1 <br /> ,.•pit c <br />