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TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />f,.. <br />6. <br />7. <br />8. <br />9. <br />Page 7 of 11 TEMP EVENT APP <br />meats, tamales, cooked beans, rice, <br />r <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />EHD 16-02 <br />08/01/16 <br />1 Viding the followin9 hot temperature control for the hot holding of all potentially hazardous foods above <br /> Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: M/J (b. <br />( Alternate: ( <rT------------------------------- <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: [pVes No <br />All food is prepared on-site or is from approved commercial facilities: EfYes No <br />Name of facility:Phone:/ ) <br />Address of facility:____________________ <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />H"Approved bottled water. <br />B'On-site hose bib that is connected to a potable water source. <br />0 0ther (specify);___________________ _______________________________________ <br />Electricity is provided for my booth’s use: E^Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: E0Yes 0 No <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />E'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 />Mother (specify):____________________________ ________________________ <br />TName of Event: Lo4 1 & cLK}, <br />All food vendors (both for profit and non-profit) are r <br />the festival coordinator three (3) weeks prior to this event. <br />1. <br /> Sterno & hotel trays <br /> Steam table & lids <br />HlSther (specify) W <C>t/c *3 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.