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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.Date(s): ^Ifc <br />2. <br />3.List <br />4. <br />1 <br />5. <br />j. <br />6. <br />7.Yes No <br />8.the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />E HD 16-02 <br />08/01/16 <br /> Camp stove <br />Ki Double steamer <br /> Electric stove top <br />C On-site hose bib that is connected to a potable water source. <br /> Other (specify):L <br />I am providing an accurate probe thermometi <br />foods during all times of booth operation: \7] <br />I am pre <br />All food is prepared ortsite or i§ from approved commercial facilities: <br />Name of facility: "Pho <br />Address of facility: <br />The following is information about my on <br />Name of organizg,tion/business:^~^XZ <br />Electricity is provided for my booth's use: <br />Ization/business: — <br />Address:Phone^r-^^ f Z5 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />ttVfTr v<;ndors <b°th f°r pr°fit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. uiecxiisi io <br />1 Name of Event: Lo J I cLK|. £1^^ <br />J <br />________ Alternate: ( ) ________ <br /> iod to be soldjH'Cji^rvto the <br />Mding fe/od that is NOT prepared at home^Yes <br />X Yes □ No <br />Phone: £ <br />1 ^s^and the public)1 f°ll0Win9: (t° protect my unpackaged food and food-preparation areas from flies, <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete <br />area^from^he^pubHc30^ Sm0°th W0°d are accePtable) and constructed to separate food and food preparation <br />[Zother (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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />jif to measure <br />Yes No <br />' arP providin9the following hot temperalure control for the hot holding of all potentially hazardous foods above <br />I 00 i .