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I <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date.s; c <br />2. <br />Address: <br />Phone:i <br />3 <br />5 <br /> Other (specify): <br />5. <br />~l Other (specify): <br />Electricity is provided for my booth's use:^' Yes O No7 <br />3. <br />9. <br />Page 7 of 1i TEMP EVENT A?s <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 />Camp stove <br />E? Double steamer <br /> Electric stove top <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods du'ing all times of booth ope'aticn: Yes EZ No <br />=HO 15-02 <br />11/4/14 <br />meats, tamales, cooked beans, rice, <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 />]^A booth with .veils and ce ng constructed of either wood, canvas, plastic, similar material and fine mesh *y <br />screening complerely 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 />^On-site hose bib that is connected to a potab e water source <br />Approved water for drinking, utensil and nand washing will be provided in my booth by the following methods. <br />""S-Approved Dotted water. <br />Name cf organization/bus ness: <br />Ac <br />List food to be sold or given to the public: f) <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135OF; <br />^^Sterno & "otel tra/s <br /> Steam table & I ds <br />^-Other (speci\'i ~h’ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 prior to this event. <br />1 Name of Event: I <br />The following is information about my organization/business: <br />> Alternate: ( <br />I am providing food that is NOT prepared at home Yes No <br />AH food is orepared on s te or :s from approved commercia faci tiesi^lYes No <br />Name cr fac.'.'y.Phone' <br />Address of facility: