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TEMPORARY FOOD VENDOR’S APPLICATION <br />i.Date(s) <br />2. <br />Address: <br />Phene: <br />3 <br />4. <br />5 <br />I I Other 'specify): <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 />7 <br />8 <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 cf 11 TEMP EVEN" APP <br />S^Camp stove <br />C Double steamer <br /> Electric stove top <br />Note: The only operations not required to p-ovide 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-preparation areas from flies <br />dust and the public) <br />=H0 15-0? <br />'1. i'14 <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />iwt. <br />r <br />®-Sterno & hotel trays <br /> Steam table & I ds <br />VQ Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />KJa booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fiy <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 />nr to measure the hot and cold holding of potentially hazardous <br />Yes C No <br />I am providing food that is NOT preoared at home: Yes No <br />All food is orepared on-site or is from approved commercial facilities. O Yes No <br />Name cf facility.Phone <br />Address of facility:_______________________________ <br />Electricity is provided for my booth's use 'N^Yes [j No <br />I am providing an accurate probe ttiermometei <br />foods during all times of booth operation: Xu 'i <br />I am providing the following hot temperature control for the hot holding cf all potentiallv hazardous foods above <br />135’F: <br />the festival coordinator three (3) weeks prior to this event. <br />1 Name of Evenr^F^/^tyt Ia -^^f _______________________ <br />The following is information about-my organization/business: / <br /> Name cf o-genizat'en/bus -1-3-5 (S - <br /> <br /> <br />US--co- '.0 Se scid or cr.en r. r r r-