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t ’ v' r o > i m ent a I H ea I th De pa r t nc < i ■; <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />8. <br />9. <br />maafcr, tamales^ cooked beans, rice. <br />TEMP EVENT APP <br />6Scanned with CamScanner <br />EHD1M2 <br />06/1W19 <br />135T: <br /> Camp stove <br /> uoubie steamer <br /> Etertnc stove top <br />Pape 7 of 11 <br /> Other (specify):________________________________________________________ <br />Note: Ihfl only operations not required to provide enclosed hooths are those which sell beverages from <br />approved dispetrssrs, or prepacKuped ibuute front approved sources. <br />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br />Date(s): 0^ <br />Notn- FYamnloi of, nntontinlly bazacdoua food Includa*. <br />vegetsbtes, potato eafad, eggs, and dairy products. <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 />I.Name of Event: <br />The following is Information about my organization/business: <br />Name of oqjarilzation/business: <br />tgUQ Ot- 5vyv\3(%- .(YA ____ <br />(^-C/l) LP n ‘ 2-^ 95 Alternate.^ ) <br />List food to be sold or given to the public: <br />1 am providing food that is NOT prepared at homejjEfYes O No <br />All food is prepared on-site or Is from approved commercial facilities^Efves No <br />Name of facility: Phone: ( ) <br />Address of facility:______ ________________________________ <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 />PYa booth with walls and ceiling constructed of either wood, canvas, plastic, similar materia! 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 />iv <br />Q Other <«pecKyy.---- ------------------------------------------------------------------------------------------------------------- <br />7. Electricity Is provided for my booth's use: LJYesJZI 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 operatlond0Yes No <br />I am providing the following hot temperatifrecontrol for the hot holding of all potentially hazardous foods above <br />^0 Stemo & hotel trays <br />Steam table & lids <br /> Otoer (specify)