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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.Date(s) <br />2. <br />Address: <br />Phene: <br />3 <br />4. <br />5. <br />LJ Other (specify): <br />6.Approved water for drinking, utensil and nand 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 />7 <br />3. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMPEVsNT = <br />Other (specify): <br />Electricity is provided for my booth's use No <br /> Camp stove <br />C Double steamer <br /> Elect' c stove top <br />I am providing an accurate probe thermometer to measure the bet and cold holding of potentially hazardous <br />foods during all times of booth operation: U Yes £j No <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 />I am providing a booth with the following (to protect my unpackaged food and food p'eparaiion areas from flies <br />dust and the public) <br /> Sterno & hotel trays <br /> Steam table & lid^ <br />CtfSther 'sper m: <br />EHfi 15-02 <br />11/4/14 <br />required to return a signed and completed copy of this checklist to <br />_ Date.i. <br />KA booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenal and fine mesh fiy <br />screening compte'.ely 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 />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 />\>o PC Q <br /> <br />I am providing food that is NOT prepared et home. H*Yes .□ No <br />All food is prepared on site or is from approved commercial facilities: O Yes T] No <br />Name of facility.Phone ( ) <br />Address of facility: <br />All food vendors (both for profit and non-profit) are t <br />the festival coordinator three (3) weeks prior to this event. <br />1 Name of Event:I <?<1 Wi <br />?he following is information about my ortjanization/business: <br />Name cf organization b..s ne-s \ <br />• 5)^41 A£ynate:( <br />List food :c be sold or giver :‘he pub c. vXQTzO ( d S