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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Nams of Event:Date(s) <br />2. <br />Address: <br />Phene:Alternate: () <br />3 List food to be sold or given to the pubiio. <br />4. <br />5. <br /> Other (specify): <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the •'oilowing methods: <br />7. <br />g <br />9 <br />meats, tamales, cooked beans, rice, <br />Paje 7 af 11 TEMP EVENT APP <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 />=H0 15-02 <br />11 M/1 < <br />Name of organization,'bus ness' <br />^1^5 <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 />5S.A booth with walls and ce mg constructed of either wood, canvas, plastic, simi’ar maters: and fine mesh f‘y <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 />I am providing food that is NOT prepared st home. V] Yes O No <br />Ah food s prepared on-site or is from approved commercial facilities <br />Name of facility. F <br />Address of facility: <br />"STApproved bottled water <br />[xOn-site hose bib that is connected to a potable water source <br />3 Other (specify): <br />Electricity is provided for my booth's useTiYes C No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: r%Yes C No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br />^Camp stove <br />C Double steamer <br />O Electric stove top <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 />Qr/ntAd1! It <br />The following is information about my organization/business: <br />__/rfiL <br />Phone £ <br />i^Sterno & hotel trays <br />SZ] Steam table & lids <br />F^Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.