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p.1 TEMPORARY FOOD VENDO =?’S APPLICATION i I.Name of Event:1. 2. Address: Alternate: ( 66 9 ) M |Phone: 3. 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. On-site hose bib that is connected to a potable water source. Other (spectfy): Electricity is provided for my booth’s use: Q Yes Q No7. 8. 9. meats, tamales, cooked beans, rice. TEMP EVENT APP ^A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from ap noved sources. Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. M Sterno & hotel trays Steam table & lids Other (specify) EHD 16-02 Moi/ie I am providing an accurate probe thermometei foods during all times of booth operation: 0^ measure the hot and cold holding of potentially hazardous 'es No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135’R / 2^es No _______________ _______Phone: (2tfl ) yj 1jlV ’—prA^l CT)__________ t Page 7 of 11 I All food vendors (both for profit and non-profit) are required to reK m a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. The following is information about my organization/business: Name of organization/business: L-X| lypyJ#/? List food to be sold or given to the public: ____________. --------------------------------Date(s): '"So <j I am providing food that is NOT prepared at home: Q'Yes No All food is prepared on-site or is from approved commercial facilities: Name of facility: ________ Address of facility: I am providing a booth with the following: (to protect my unp rckaged food and food-preparation areas from files, dust and the public)