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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: Z�rl I o Date(s): <br /> 2. The following is information about my organ ization/businesss: f <br /> Name of organization/business: b� I F?� l/t h-ID S W, <br /> Address: E <br /> Phone: (� j ) s �C' SS Alternate: ( ) n <br /> 3. List food to be sold or given to the public: 4LMbUr ,"y c.j n C -� <br /> 4.- 1 am providing food that is NOT prepared at home: Yes ❑No <br /> All food is prepared on-site or is frem+approved commercial facilities:XYes❑ No <br /> Name of facility: L �'r� cry ' 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 /> f <br /> i"r A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly F <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 /> ❑Other(specify): <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 /> 3 <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 /> ❑On-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 thermornpte. to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation-. Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: <br /> r <br /> ❑Camp stove ❑ Sterno&hotel trays <br /> ❑ Double steamer _R151eam table&lids <br /> ❑ Electric stove top N 'tther(specify) 131 4-r-- ey, <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> EHO 1"2 Page 7 of 11 TEMP EVENT APR <br /> 7114116 <br /> 4 <br /> E <br />