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TEMPORARY FOOD VENDOR’S APPLICATION <br />d'f -iiDale(s):1. <br />2. <br />^11 Address: <br />Phone: <br />3. <br />4. <br />a-J-a <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods;6. <br /> Approved boltlcd water. <br />7. <br />3. <br />9. <br />moats, tamales, cooked beans, rice, <br />TEMP EVEN T API’ <br /> <br />P.i<10 / Of 11 <br />I <br /> <br /> I <br />i <br />END 16-02 <br />7/14/15 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 /> 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 wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify): V6L0 t <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 />! <br /> Alternate: ( ) <br /> On-site hose bib that is connected to a potable water source. <br />0 Other (specify): A& <br />Electricity is provided for my booth's use: Q'Yes No <br /> Sterno & hotel trays <br /> Steam table & lids <br />IV. Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 <br />1. Name of Event: <br />I am providing food that is NOT prepared at home: 0 Yes O No <br />All food is prepared on-sjte or is from approved commercial facilities: CZl’Yes No <br />Name of facility: I Phone: £1 <br />Address of facility:I ___________________________________ <br />The following is information about my organization/business: <br />Name of organization/business: ai i6T <br />I® ia)- l-A - ttbUte <br />fzU/) <br />List food to be sold or given to the public: ; <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: H Yes [54 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: