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TEMPC kRY FOOD VENDOR'S APPi 4C, ON <br /> All food vendors (both for profit end are requ rec to return a signed and completed copy o`'-vs checklist to <br /> t're festival coordir.at r tt-ree =_ _ _r to this event. <br /> l #�6 �' PP C l8 <br /> 1. 1 P�lame of Eveni: �_�t�� ����•�=T e,f�J e,�l Da`.e;s Oct*�t t_Z_+l - <br /> 2. The following is information about rmy c-:ian:zationlbusi^ess <br /> Namecforgan,Lat�an;a::s,ness: ,(�csSt—�:s/�h,, i,l <br /> Address y Pact in �A - t�t?� <br /> Phc^e: Y31 ',AqQ=� �Q ---- Alternat c $ 3� i �_�_-,�—�_2 <br /> 3 Ust`occ'ouz sold orOh il /Lr�y�� stibc«f `r' ��'?1c­ni2�:f�91• <br /> 4. 1 am ;�rcviding food that is NOT prepared at home N'Yes <br /> All.food is preoared cn A or is from approved commerc;al fac. :!-L_� Ayes ] No <br /> Name cf fsci'::y. _ Phone <br /> Address of <br /> 5 1 a n providing a booth with the following (to protect my unpackaged food and food-preparation areas from flie_ <br /> d:,st and the public) <br /> >-4.,A booth with walls and cc-istructed of e t`'er wood, canvas. plastic, similar material and fine mesh f',v <br /> screening, completely e^closing open food areas it wai a'so have a smooth and cleanable floor (Corcrete, <br /> asphalt, clean tarps and smooth v✓ood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> 1 j Other specify): <br /> Note: The only operations not required to provide encicsed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods rrom approved sources. <br /> Approved water for drinking, utansil and hand .vas^irg v,is be provided in my booth by the foliay.,ing methods: <br /> Z'Approved bottled water. <br /> i- On-site hose bib that is connected to a potable water source <br /> Other(specify;: <br /> A7 Electricity is provided for my booth's use: Yes❑ No <br /> 3 I am providing an accurate probe tl-ermorneter to measure the hot and cold �oldirg of potent;ally hazardous <br /> (cods during all times of booth operation:1t Yes C No <br /> ?. 1 am providing the fol:owing hot temperature cortrcl for t"e hct holding of all potentially hazardous foods above <br /> 135T. <br /> -4Ca rfo stove St erno&rot_l t-a,.,,s <br /> C Double steamer ]Steam tab'e&I:ds <br /> C Electric store top ,2 Other'soec'y) pep -C-ryCC% <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> r <br /> Pag='-f Si TEfd? <br /> 71414 <br />