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_ 5 <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prioErA this event. <br /> 1. 1.Name of Event:J TC,)1 `_ Date(s): <br /> 2. The following is information about my o(rganization/business: <br /> Name of organ ization/business: I Ad,�> ' o r U 0�r 0_cC <br /> Address: 5_k <br /> Phone: 53of �O IV, Alternate: <br /> 3. List food to be sold or given to the public: ' T , ��►- � � des s ._ <br /> 4. 1 am providing food that is NOT prepared at home. (g Yas❑ No 7` <br /> All food is prepared on-site or is from approved commercial facilities: F'Yes❑ No <br /> Name of facility: -Tmv _C—Vl m Phone: (50p <br /> Address of facility:x , ---I _-- <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar 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 smooth wood are acceptable)and constructed to separate food and food preparation <br /> areas from the public. <br /> K/ther(specify): <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. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> Other(specify): <br /> 7. Electricity is provided for my booth's use: E Yes❑ No <br /> S. I am providing an accurate probe thermom�etyto measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ffYes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer Vsteam table&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 /> EHD 16-02 Page 7 of 11 TEMP EVENT APP <br /> 11fA114 <br />