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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-protit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event. 1 —, /_ <br /> 1. 1 Name of Event: <br /> q( ( 2 <br /> 2. The following is information about my organ:7atioQ! siness, , <br /> Name cf organize`,nn'b;:s'.ness: <br /> Address: <br /> Phcne: <br /> List d .e sold or giver, ,,e p:: ����L_����C U J e <br /> I am providing food that is NOT prepared at home: ❑"es [?,No <br /> All food is prepared on site or is from approved commercial facilities. ❑ Yes[moo <br /> Name of facility: Phone <br /> Address of facility: <br /> 5 1 am providing a booth with the following. (to protea my unpackaged food and food-preparation areas from flies <br /> dust and tl,e public) <br /> ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, simi',ar 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 smoct, wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> (Other(specify): ` D M C) <br /> Note: The or'y 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 washing will be provided in my booth by the Mowing methods: <br /> &<pproved bottled water. <br /> L]On-site hose bib that is connected to a potable hater sour-ce <br /> ❑ Other(specify): _--- <br /> 7 Electricity is provided for my booth's use- ❑ Yes❑ No <br /> B. I am providing an accurate probe thermometer to measure the hot and cold I-oldirg of potentially hazardous <br /> foods during all tunes of booth operation: ❑ Yes C No <br /> 9. I am providing the folioyring hot temperature control for the not holding of all potentially hazardous foods above <br /> 135'F. <br /> ❑ Carip stove ❑Ste,no& hotel trays <br /> [' Double steamer ❑Stearn`.able&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 /> _,,J 1:—2 Peg?!7 cf 11 TE'•:P EVEN-Ann <br /> -:r.i1, <br />