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f • 12019 temp food app ma1n2.lpg TEMPORARY FOOD VENDOR'S APPLICATION Ali food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the festival coordinator three(3)weeks prior t this evert. 1. 1.Nance of Event 59t oCk_:A chnsEta V L.4s7Fj� Date;sk �1��' 2. The following is information about my organ izationibusiness Name cforganization/business Address Tb —?, cm- Phone: (4T111.)�L �j��tZ�' Aitemate:(I)'6) 2;UA-1%3jQ List food to to sold or given to t"e public. %`! K%,A PkN +4 _. 4. 1 am providing food that is NOT prepared at home:,05—dYes❑No AI food is prepared on-site or is from approved commercial facilities.01 Yes❑No Name of faci;ity.�l Phone Address of facil.ty: �Anv_ 5 1 am providing a booth with the following:(to protect my unpackaged food and food-preparation areas from flies, dust and the public) ❑A booth with walls and ceiling constructed of ether wood,canvas,plastic,similar material and fine mesh fly screening, completely encbsing open food areas. It will also have a smooth and cleanable flour (concrete, asphalt,clean tarps and smooth wood are acceptable)and constructed to separate food and food preparation areas from the public. A Other(specify):_LOt,i F'(2F_?1 A!whG +G S'CDfz�t17 f�) BPIF .?fig 1=+err 1 C.r►s1�lG�� Note: The only operations rot required to provide enclosed booths are those which sell beverages from aporoved dispensers,or prepackaged foods from approved sources. S. Approved eater for drinking,utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable:eater source. Other(specify): 7. Electricity is provided for my booth's use:(-.Yes❑No E. i am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous I oods during all times of booth operation:❑Yes❑No 9 am providing the fol:owing hot temperature control for the hot holding of all potentially hazardous foods above 135`P: rJ Can-ip stove L-1 Sterno&hotel trays Double steamer ❑Steam table&lids G Electric stove top ❑Other(specify) Dote: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, vegetables,potato salad,eggs,and dairy products. 54p t.-.,. f';;n•: c!t t TEf;5 E1_K'A•' ,.1.