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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and ion-profit) are required to return a sigred and completed copy of this checklist to <br /> the festival coordinator three(3) :.e_-::s prior to this event. <br /> 1. 1.Name of Event:�Z � �' f S7/y�3 / Date s):!f 2.n//Y- <br /> 2. The following is information about my organization/business: <br /> Name c` rg_ni-v,-/bus ness: <br /> Address: 2OZG er,4? <br /> Phone: t. ) '1 ff 6S� Alternate: ( j <br /> 3 List foc14,o~e said ar gtven to tha public <br /> 4. 1 am providing food that is NOT prepared at home: ! '--s No <br /> All food is prepared on-site or is from approved commercial facilities: L4 es No <br /> Name cf facility. t!r i.✓ Pr U Phone: ( <br /> Address of facilry: ��C1 <br /> 5. 1 am providing a booth tivith the following: (to protect my unpackwged food and food-prepa;atio❑areas from flies.. <br /> lost and the public) <br /> UA-biooth 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 deanable itoor (concrete, <br /> asphalt, dean tarps and smooth wood ara acceptable) and constructed to separate food and food preparation <br /> areas from fhe public. <br /> ,her( peciry): <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 /> 5. ApYroved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> 0 Other(specify'): <br /> 7. Electricity is provided for my booth's use:❑Yes <br /> 8. I am providing an accurate probe thermometer�fE71 <br /> asure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: o <br /> 9. i am providing-he following het t;mperature control for the hot holding of all potentially hazardous foods above <br /> 135-F: <br /> r <br /> IID Ca71 stove ❑5terno&hotel trays <br /> E7 e steamer ❑Steam fable&lids <br /> n - c ni 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 /> =H ;_-az Page ,a;; 7= <br />