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TEMPORARY FOOD VENDOR’S APPLICATION <br />‘ \an-e of Event' ~Vc <br />L05 ___A^cress-S3 3 Fr/x <br />Pncne:- Mofc )Al'.e'na'.e ( <br />oAeql'g <br />£. <br />5 <br />[_j O:ber ;scec.fy): <br />Approved water for drinking, utensil ard nand washing will be provided in my booth by the Allowing methods:5 <br />App-oved oottled v/ater <br />~] On-site hose bib that :s connected to a potable water source <br />a <br />9 <br />meats, tamales, cooked beans, rice, <br />TEM3 EVEN" A33Paj» 7 ef 11 <br />Z2 Other (specify): <br />Electricity is provided for my booth's use (X Yes No <br />Camp stove <br />E? Double steamer <br />Lj Electric stove top <br />Note: The only operations rot required to provide enclosed booths are those wh en sell beverages from <br />approved dispensers or prepackaged foods from approved sources <br />I am prov ding a boclh with the following (to protect my unoackaged food and food-p'eparation areas from flies <br />dust and the public) <br />Xi Sterno & hotel trays <br /> Steam table & lids <br />S3 Other (specify) dosp - <br />Name cf organization.bus ness JET V>o <br />XjOqjd/A_ Jr___ <br />VI M**______ <br />L ct *ood to be sold cr given to ‘he pub o V4o4dpA e» <br />jX A booth with walls and ce ling constructed of either wood, canvas, plastic, simi'ar material and fine mesh fy <br />screening completely enclosing open food areas. It 'will also have a smooth ano 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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />EH3 1’<? <br />•• <-14 <br />S HCka \ 7 1 707 q <br />• 1-7^ <br />I am prcv.ding food that is NOT oreoared at home Yes No <br />All food s orepared on s te or is f'om approved commercial faci! ties S’Yes No <br />Name cf faci'lty.Propose J n n Phone (i <br />Address of facility:__________________________________________ <br />I am providing an accurate probe thermometer to measure the rot and cold bolding of potentially haza-dcus <br />foods during all times of booth ope'ation.J>5 Yes C No <br />I am providing the fol'owing hot tempe-ature control for the hot holding cf all potentially hazardous foods above <br />135T: <br />All food vendors (both for profit and non-profit) are reaui'ed to return a signed and completed copy of this checklist to <br />•be {est vai cor-di-ator three (3) weeks poor to this evert <br />-$Xvo+- <br />The fol owing is ir'c-mat on about m.y organza'.ion/busmess