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� a <br /> TEMPORARY FOOD VENDOR'S APPs(CAT fON <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 pri,^, "'3 a t. <br /> 1. 1.Name of Event f° Dates) <br /> 2. The following is information abo , y organization/business, 9" <br /> O <br /> Nacre cf o�ganization/bus',ness we <br /> Address: P,02�oc <br /> Phone: { Gam//�— / �V� I:=_mata: t j <br /> 3 List`cod to be sold or given to the pubic. <br /> IF <br /> 4. 1 am providing food that is NOT prepared at homer] Yes No <br /> All food is prepared on-site or is from approved co:, merciai facilities: ❑Yes❑ No <br /> Name of facility. Phony <br /> Address of facility: <br /> 5 1 am providing a booth with the following: (to protest my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> tV,A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> reen:ng, 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 /> 711 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 hand washing will be provided in my booth by the following methods: <br /> pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> _i Other(specify):_ _ <br /> i Electricity is provided for my booth's use:,Yes[j No <br /> 8. I am providing an accurate probe thereto e r to measure the hot and cold "oldirg of potentially hazardous <br /> foods during all times of booth operation:/K!Yes C No <br /> 9. 1 am providing the following hot temperature control for the hot holding cf all potentially hazardous foods above <br /> 135°F: <br /> camp stove �Sterno& hotel trays <br /> Double steamer Steam`.able&fds <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 /> =nD 15-02 al?7 TEMP EJch-A:�P <br /> 1;E'14 <br />