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1 P <br /> L <br /> F <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> k <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_)Qwpe'ee+ks prior to this event. (� 'n <br /> 1. 1.Name of Event: 'IliV� `Ur M �� Date(s): v��� 1 <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: �J�1� � <br /> Address: 1 l e a K� Et IRA 0 <br /> Phone: (2) q 1m— 16i Alternate: ( ) <br /> 3. List food to be sold or given to the public: <br /> � <br /> Ij <br /> 4. 1 am providing food that is NOT prepared at home:S/yes❑No . <br /> All food is prepared on-site or is from approved co merci I facilities: Yes❑No 7 <br /> Name of facility: Phone: ( <br /> . �°G�"�'CJ <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 /> [�\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 /> ❑Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from f <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 /> ❑On-site hose bib that is connected to a potable water source. <br /> [Other(specify): V\ 1 �( <br /> S <br /> 7. Electricity is provided for my booth's use: ❑Yes❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes❑ No A , J r <br /> 9. 1 am providing the following hot temperature control for the hot holding o all potentially hazardous foods above i <br /> 135'F: <br /> e <br /> ❑ Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids t <br /> ❑ Electric stove top ❑Other(specify) <br /> C <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, t <br /> vegetables,potato salad, eggs,and dairy products. <br /> G <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 7/14/15 e <br /> s <br />