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5 <br /> S <br /> E <br /> 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 priorprior to this event.} c C <br /> 1. 1.Name of Event: 1 C,�1�5 Date(s): v` <br /> Z The following is information about my organ ization/business: <br /> Name of organiizzatiio'nn//business: d JC,, (J ;aA_)S y`/0(1\J <br /> Address: �" U Phone: M) `/ <br /> ZV1 L�� Alternate: ( ) <br /> 3. List food to be sold or given to the public: 1 ykC o <br /> 4. 1 am providing food that is NOT prepared at home:KYes ❑No <br /> All food is prepared on-site or is from approved commercial facilities: KYes❑ No i <br /> Name of facility: Phone: ( ) <br /> Address of facility: <br /> e <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 <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 /> *n-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 thermom ter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:AYes❑ 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 Wther(specify) <br /> a <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, i <br /> vegetables,potato salad, eggs,and dairy products. <br /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 7/14/15 <br />