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f ` <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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' .-.leeks prior`0 this event. <br /> t. 1.Name of Event: -2 � _ Dates) 74-Ul_ � <br /> 2. The following is information about my organ ization1business <br /> Name cf organization/busness:+-.-=D_ :J�:-aF _ <br /> Address: - <br /> Phone: > �_ i'!� Alternate: t — LQ ) <br /> 3 List food to be sold or given to the pudic. <br /> 4. 1 am providing food that is NOT prepared at home. Yes ❑ No <br /> All food is prepared on-site or is,from ;roved c• ,-I in f c1';ies. Yes❑ No <br /> Name of facility: � o hone 1_ q05 _ <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 /> ❑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 %Vood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. ]j �^ <br /> Other(specify): \ E x <br /> Note: The only operatic -, not req- _u to provide enclosed booths are those which sell beverages from <br /> approved dispense s or prepa-_:aged foods from approved sources- <br /> 3. Approved water for drinking, utensil and hand wasf;ing 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 /> 0 Other(specify): <br /> 7 Electricity is provided for my booth's use: ❑ Yes%No <br /> I am providing air -c_urate probe thermometer to measure tie hot and cold holding of potentially hazardous <br /> gods d ~r =_Il- - s cf booth operation: Q Yes C No <br /> 1 an, Vo,vl: :he fol:or;ing hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> _]Camp stove ❑Ste, <br /> e-no&hotel tra;,s <br /> Q Double steamer ❑steam able&lids <br /> ❑ Electrfc 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 /> _ .. Page-..ft; _._, _- <br />