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TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required io return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior to this event. 1. 1.Name of Event: Date(s): 2. The following is information about my organizationlbusiness: Name of organization/business: cl� rVa� G Address: �_3g G � Phone: (L ) LW l Alternate: ( ) 3. List food to be sold or given to the public: • �� ' °K 4: 1 am providing food that is NOT prepared at home:AYes❑ No All food is prepared on-.&te or is from approv commercial facilities: XYes❑ No iz.f� �0UAY?(K-L- Phone: � �Name of facility: ?..., Address of facility: " 5. 1 am providing a booth with the following: (to protect my unpackaged food and Toad-preparation areas from flies, duat and the public) gA booth with walls and ceiling constructed of either wood, mrivas, plastic, similar materiel and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clears tarps and smooth wood are acceptable) and constructed to separato food and food prepor'otion areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the fallowing methods: ❑Approved bottled water. ❑On-site hose bib that is connected to a potable writer source, ff 2 Daher(specify): do—Sri JW5F_ 7, Electricity is provided for my booth's use: KYes Q No 8. 1 am providing an accurate probe tharmomotor to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: gYes❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135"F: Camp stove D .Stemo&hotel trays ❑ Double steamer Z Steam table&lids Electric stove top ❑Other(specify) Note: examples of potentially hazardous food Inctuft meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. EHD 19-02 Paya 7 of 11 TCMP EVENT APP 7l1A115 l* /� 1 unil non � /r1 III �,I1• 11111.1 AA •1111A /"i / /"� �/ /+1h�