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TEMPORARY FOOD VENDOR'S APPLICATION <br /> AlI 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. c�^ <br /> 1. I.Name of Event e-#%d o e a W1,00-4. _r 19157 Dats(a): 7 <br /> 2. The following is information about my or+ganization/business: <br /> Name of organmation/busirHas: I 0" <br /> Address: C 2L <br /> Phone: 5"4a Alternate: ( ) _.__---- <br /> 3. List food to be sold or given to the public: t44 h Il — /� <br /> r M+i 4a.,ne.., �-�/ X44 1a <br /> 4: 1 am providing food that is NOT prepared et home:0<eal�❑No <br /> AJI food is prepared o"ite or is from approved commercial facilities: Yes❑No <br /> Name of facility. Phone;l� ). 3.47- 1CP_ <br /> Address of facli ty: "§tt i !A rrawc> <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 /> ❑A booth with walls and coiling constructed of either wood, canvas, plastic,simArrr rrlsrterial 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 /> Other(sAeafy): �. rev <br /> Note: The only operations not required to provide enclosed booths are those which sail beverages from <br /> approved dispensers,or prepackaged foods from approved sources. <br /> 8. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-aft hose bib that is connected to a potable water soureA. <br /> other(specify): ✓►, <br /> 7. Electricity Is provided for my booth's use: Yes 0 No <br /> 8, 1 am providing an accurate probe therrrtomet�measure the hot and cold holding of polontisRy hazardous <br /> foods during all times of booth operation: [�rYes❑No <br /> 9. 1 am providing the following hot temperature control for the hat holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑camp stove ❑Stemo&hotel toys; <br /> W[ T)o ble steamer ❑Steam tsWe&lids <br /> lectric stove top Cj76ier(specify) S' rr t "C <br /> Notre: Examples of potr/ntialty hazardous food include. meats, tamales, cooked beans, rice, <br /> vegetables,potato selod,eggs,and cWry produats. <br /> EHD ie-02 Paige 7 of 11 MEW EVENT APP <br /> 7114/16 <br />