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a � <br /> TE10PORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a sicned and completed copy of this checklist to <br /> � <br /> the festival coordinat . 3)vveeks p-i:- th s . =nt. I _ <br /> 1. 1.Name of Event: n �/,Juq-vA L�l l �P Date(s) <br /> 2. The following is information about r-. ationlbus, <br /> Name cf organi'' <br /> s <br /> Address `e [, <br /> Phone: _ k <br /> List food to be sold or giver,tothe p a,�, 'GY <br /> 4. Ism providing food that is NOT preaa ed 2t noire. M Yes ❑ No <br /> All food is prepared on site or is from approved commercial facilities: E. <br /> Name of facility. Phone _- <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> d,,st and the public) <br /> � <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 /> ❑ Other;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 /> 3. Approved water for drinking, utensil and nand washing w^l'be provided in my booth by the following methods: <br /> [Y 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: Cis❑ No <br /> 3. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑ Yes C No <br /> 8. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑Camp stove ❑Sterno& hotel try <br /> ❑ Double steamer ❑Steam table&lid- <br /> ❑ Electric stove top [TO— Uther(specify) V ` <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products, <br /> ,-yap-nf,, TEvn r-N- <br />