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Date(s): 1. <br />2. <br />Name <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />| <br />meats, tamales, cooked beans, rice, <br />ter to measure the hot and cold holding of potentially hazardous <br />I Yes No <br />O 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 />Approved water for drinking, utensil and hand washing 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 />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 /> Stemo & hotel trays <br />Steam table & lids <br /> Other (specify) <br />M--------------------- <br />-Y4 <br />fa u <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth’s use:^j Yes No <br />I am providing an accurate probe thermoc <br />foods during all times of booth operation) <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />^0 Camp stove <br /> Double steamer <br /> Electric stove top <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 prior to this event. <br />1. Name of Event: <br />The following is information about my organization/business: <br />of organization/business: ft <br />U33~~l ZJ. <br />( Alternate: <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: |x( Yes No <br />All food is prepared on-site or is from approved commercial facilities: ^Yes No <br />Name of facility:Phone: (1 <br />Address of facility:__ ____________________________ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />SA 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 wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.