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i TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1"r, I 1, 1,Name of Event&l i 00k y A,I-e*\, '�,YV�2s� Date(s):Ape" _� 2. The following is information about my organization/business: Name of organ ization/business: FA I U nA" meA t 4 Address: l JAsOO sf VY1AN-CCA Gar -15?J�Jt p n Phone. { ) 12- Alternate: (Ul ) �0—t pr 3. List food to be sold or given to the public: fi t'I -j Sq h W G if i n k� 'T u r kC J r+n m ri p h i Ps i S 0a4,1 Wet R� 4. t am providing food that is NOT prepared at home:®Yes❑No All food is prepared on-site or is from approved commercial facilities: Q]Yes[]No Name of facility: ��A kA n CALS (KZ0 S Phone: (1J) ; 2 3 J I Address of facility: 42_j a S0 S� _gyp GA Pr �1 S 33 {o 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with wails 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, I asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ((�� Other(specify): F d U J TI�r U 05/ Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers,or prepackaged foods from approved sources. ^o. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: B Approved bottled water. On-site hose bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my booth's use: 2�Yes❑No 8. 1 am providing an accurate probe thermomet to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: Yes.❑No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: ❑Camp stove ❑Sterno &hotel trays Double steamer team table&lids ❑ Electric stove top 0 Other(specify) Note: Examples of potentially hazardous food include: meats. tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. `Nn ISO' 1: g,7:p rLMP EVENT APP 08I0'/1 b