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F � TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and ^:)}-profit) are rec.: ed to return a signed and completed copy of+his checklist to the festival coordinator three(3)vreeks prior to this eN= 1. 1.Name of Event: --Y---0j _j _. c�c ` . - De=_ 2. The following is info-r,,at.on ac , organ; d;:gin:pus+ne Name c` -aaniZ Address _-Lc.2J• 0A Phone: (�e�'t) ��'QZ.►C'1.0 - -- - - - = t S�M � _. 3 List food to be sold or given to the public. — 4. 1 am providing food that is NOT preoaree.at home. %Yes(] No All food is arepared on-site or is from approved commercial faci'ities. ❑ Yes® No Name of facility: Phone Address of facility: 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. dirt and the public) %A booth with walls and ceiling constructed of either wood, canvas, plastic. similar material and fine mesh fly screening, completely enclosing open food areas. it will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable)and constricted to separate food and food preparation areas from the public. ❑Other(specify): Note: The only operations not required to provide enclosed booths are those which self beverages from approved dispensers, or prepackaged foods from approved sources. o. Approved water for drinking, utensil and hand washing will be provided in my booth by the foilov7ng methods: Approved bottled water. On-site hose bib that is connected to a potable water source. Other(specify): i Electricity is provided for my booth's use �Yes❑ No S. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 4 Yes ❑ No 9. 1 am providing the following hot temperature control for the hot holding cf all potentially hazardous foods above 135'F. 14camp stove ❑Sterno& I-:otei trays E Double steamer ❑Steam table&lids ❑ Electric stove top ❑ Other(speci4v; Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs,and dairy products. Stir.t_. 7 page" „ it Tr_, o.Z1,- f'16 -