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TEMPORARY FOOD VENDOR’S APPLICATION <br />7-3 0 ■■ zc /6j )-1. Name of Event: R x \J b << n «\l •z <Date(s):1. <br />2. <br />t/vk o , (JjAddress: <br />Phone: <br />3 Vi/4 K < r-j3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />?Electricity is provided for my booth’s use: Yes No7. <br />8. <br />9. <br />f? Coen <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />\ <br />EHD 16-02 <br />7/14/15 <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 />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 /> Sterno & hotel trays <br /> Steam table & lids <br />S Other (specify) <br /> Camp stove <br />0 Double steamer <br />0 Electric stove top <br />Alternate: ( <br />The following is information about my organization/business: <br />Name of organization/business: D <4 Z.Z. f < <br />t’ o 8ox k>3 \____ <br />2 3 o ^0 <br />/ ^? r|'i o > t <br />All food vendors (both for profit 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. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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: £3 Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />fsj 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 />I am providing food that is NOT prepared at home: Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: Phone: I <br />7 <br />Address of facility: <br />List food to be sold or given to the public: (e CoiZ