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4 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1 Name of Event:- JI <br />2. <br />Name cf o'gsnizajon bus ness <br />Phene <br />4 <br />Phone ’ <br />5 <br />_J O:*er (soecify): <br />5 Approved water for drinking, utensil and nand wasning w I be provided in my booth oy the 'oilowing methods <br />Approved bottled water <br />[J On-site hose bib that s connected to a potable water source <br />1 Other (specify) <br />Electricity is provided for my booth’s use- CTYes 0 No <br />3 <br />9 <br />Pape 7 nf 11 TEMP E\ EKT - <br />Note: The only operations not required to provide enclosed booths are those which sell beverages xrom <br />approved dispense-s or prepackaged foods *'om approved sources <br /> Car p stove <br />[J Double steamer <br />J Electr o stove top <br /> Stemo & hotel trays <br /> Steam table & I ds <br />LsJ-Other (specify.) <br />=HO 15-02 <br />■■ -'•’14 <br />EZ A booth with walls and ce :ng constructed of either wood canvas, plastic, simi'ar material and fine mesh fly <br />screening completely enclosing open food areas. It will also have a smooth and cleanable ’loor (concrete <br />asphalt clean tarps and smooth wood are acceptable) and constructed to sepa-ate food and food preparation <br />areas f-om the public. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the not holding of all potentially hazardous foods above <br />135’F. <br />meats, tamales, cooked beans, rice. <br />I am providing food that is NOT prepared at home Yes [J No <br />All food s prepared on site or is from approved commercia foci'ties ~ Yes Nc <br />Name cf facility vyftlU-Q <br />Address of fao:iit\’r2>./2"Z' _ ^^7*" <br />I am providing a booth with the following (to protect my unpackaged food and food-p eparaiion areas from flies <br />dust and the public) <br />■ \ <br />All food vendor (both for profit and non-profit) are required to return a signed and completed copy of‘his checklist to <br />•re festival cor'dinator three (3) wee--s prior to th s evert <br />(4 <br />The fol owing is information about my orgamzation.'bus - >. <br /> 'WUkDcLQqjLgS_ <br />Address (W <br />1 TZ__________________ <br />List food: . » j or given t the <br />I am providing an accurate probe thermometer to measure the -ot and cold ‘■oldirg of potentially hazardous <br />foods during all times of booth ope-ation. Zy^es P No