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s i! TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three(3)iw�"eeekss prior to this event. 'n 1. 1.Name of Event: l b"�►Uv� D&I Date(s): �� ' - I W 2. The following is information about my or anization/busin s: Name of organization/business:w6� W � I U (p Address: AIN I po&Y- (_-�V ��-�F— I Phone: ( '� ' `' -7eW<3 Alternate:( ) 3. List food to be sold or given to the public: 4: 1 am providing food that is NOT prepared at home: RYes ❑No All food is prepared on-site or is frorp approved commercial facilities: A Yes❑ No Name of facility: M Phone: ) Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly c eening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which sell beverages from t approved dispensers,or prepackaged foods from approved sources. 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods.- El Approved bottled water. ❑On-site hose bib that is connected to a potable water source. ❑Other(specify): 7. Electricity is provided for my booth's use: IvYes❑ No 8. 1 am providing an accurate probe thermomeiyer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation:AYes❑ No 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135'F: ❑Camp stove ❑Sterno&hotel trays ❑Double steamer VStearn table&lids ❑ Electric stove top Other(specify) i/ - ��}—v��i1 wle 1 Vuv Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad, eggs,and dairy products. Y EHD 16-02 Page 7 of 11 TEMP EVENT APP 7/14/15 n 3 3 3