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I <br />< <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />2. <br />Address: <br />Phone: <br />3 List food to he sold or given to the public: <br />4 <br />5 <br />Q Other (specify): <br />6 Approved water for drinking, utensil and hand washing will be provided in my booth by the •'□ilowing methods: <br />Approved oottied water. <br />i ] On-site hose bib that is connected to a potable water source <br />7 <br />3 <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APT <br />Note: The only operations not -equired to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Other (specify): <br />Electricity is provided for my booth's use Yes O No <br />=H0 15-02 <br />11Z4Z14 <br />Oat: < <br />^Camp stove <br />C Double steamer <br /> Electric stove top <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 />ij&A booth with walls and ceiling constructed of either wood, canvas, plastic, simi’ar material and fine mesh fly <br />screening compleiely 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 />I am providing food that is NOT precared at home. §2.' as No <br />AH food s orepared on site or is from approved commercial facf ties Tu Yes No <br />Name of facility.Phone f) <br />Address of facility: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <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 ope'ation: X, Yes I— No <br />All food vendors (both for profit and non-profit) are i <br />the festival coordinator three (3) weeks prior to this event <br />1 -j-- -■ Even:: \Sql>lua~__ <br />The following is information about my organization,'business: <br />Neme of o-gsnizat.'cnrbus ness Tue.^ <br />tT53T, <br /> Alternate:'