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l <br /> is <br /> TEMPORARY FOOD VENDOR'S APpUCATION l <br /> All food vendors (both for profit and non-proft) 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. 1.Name of Event:*�L4 <br /> 2. The following is Information about my organization/business: r <br /> I, <br /> ACIName of organizationibuslness: <br /> � � 4 <br /> i <br /> Address: III' <br /> [� <br /> Alternate: <br /> Phone: <br /> 3. List food to be sold or girq{en to t"public: <br /> �. i am providing food that is NOT prepared at home: Yes El No <br /> cilities: Yes Na <br /> A}1 food is prepared on-site or is from approved commercial fa [� _ <br /> Name of facility; � Phone: ,ar <br /> Address of facility: Lt <br /> providing a booth with the follav�ing: (to pro#act my unpackaged food and food-preparation areas from dies, j <br /> 6, i am pr g 4 <br /> dust and the public) j l <br /> ❑ canvas, plastic, similar material and fine mesh te, <br /> A booth with walls and ceiling constructed of either wood, <br /> screening, completely enclosfrig open food areas. it will also have a smooth and cleanable floor (concrete, <br /> asphalt,clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Nf Other(specify); <br /> Nate: the only operations not required to provide enclosed booths are those which sell beverages from <br /> �i <br /> approved dispensers,or prepackaged foods from approved sources. } <br /> Approved water for drinking, utensil and hand washing will be provided in myy <br /> booth by the following methods: <br /> 6. k <br /> OK/Approved bolded water. IE <br /> On site hose bib that is connected to a potable water source, <br /> i <br /> other(specify): <br /> 7. Sectxtclty is provided for my booth's use'. +L<Y es 0 No <br /> i <br /> otential! hazardous t <br /> & 1 am providing an accurate probe thermomek to measure the hot and cold holding of p Y { <br /> foods during aq times of booth operation: Lj Yes 0 No <br /> g, t am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> Q Camp stove ❑ Stemo&hotel trays <br /> [double steamer Rrstearn table&lids i <br /> ❑Electric stove top ❑Other(specify) l <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, !� <br /> vegetables,potato salad, eggs,and dairy products. <br /> 1 <br /> TEMP EVENT APP <br /> Page 7 of 11 f <br /> EH❑18.02 <br /> 71'4 dlt5 — <br />