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• ra <br /> !19 temp_food_app_main 2.jpg <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(.both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> I <br /> he festival coordinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event: / G / /1 �/¢ -y'' <br /> .r( ��-�l Date(s). <br /> 2. The following is information about my organizationlbusiness, <br /> Name of organization/business: <br /> s �'- lc= /9;5 Gi <br /> Address: <br /> Phone: ( J i! ;7_2 2 __ Alternate:( j <br /> e s or aiveP to e p.. (ic 2- �y / j� 0'T <br /> 3 L st fog to c s -o} t b ��'/l��1Ll,r,�/�IQ �-lf��� 'J�LS` /�7' /z?O S11' <br /> ;. 1 am providing food that is NOT prepared at home:&Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities Yes❑No <br /> Name of facility: W. k-G�phon= (9''J ��I� - �7 r <br /> Address of facility:n1� 1/ i�7�1(. 15z— V <br /> 5. I am providing a booth with the following: fto protect my unpackaged food and food-preparation areas from fuss <br /> dust and the public) <br /> ❑A booth with walls and ceiling coast.uctad of either woad, 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 /> '­r_Nther rspecify): <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 /> o. Approved water for drinking,utensil and hand was^ing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> On-sile hose bib that is connected toa��potable water source. <br /> Other(specify).- � <br /> 7 Electncity is provided for my booth's use:❑Yes❑No <br /> 8. I am providing an accurate probe thermofter to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth cperatio Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ID Camp stove E3 Ste,no&hotel trays <br /> Double steamer Gleam table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> c4D 15-p2 Page 7 cf 11 TEt6P c : .:-i <br /> e;t. _._t' <br /> https://mail.google-com/mail/u/0/#inbox/FK4fcgxwChcgKzKxJlmvDPQwhwzrsDJW W?projector-1&messagePartld=0.1 1/1 <br />