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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) 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: _Date(s):_dv!hd <br /> 2. The following is information about my organ ization/business:Name of organization/business: 0 I" �`� A= Vh- <br /> c <br /> Address: �f� �' J .�aPJot tc/ P, <br /> Phone: ( 7C`�j (�� �D Alternate: q ` y <br /> 1 <br /> 3. List food to be sold or given to the public: 1'l�s, f U�oec�S <br /> 4: 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Ewes ❑ No <br /> Name of facility: B?'1 �/`� Phone: ( ? <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ilzn <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, completely enclosing 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 /> r- <br /> ❑ Other(specify): `• (�- �'� W <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> �(tn-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: 'Yes ❑ No <br /> 8. 1 am providing an accurate probe thermon�e r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: fY&Y es ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑Camp stove ❑ Sterno& hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> Electric stove top Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> EHD 16-42 Page 7 of 11 TEMP EVENT APP <br /> 7/14/15 <br />