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TEMPORARY FOOD VENDOR’S APPLICATION 1.1. Name of Event; Date(s); 2. Address; Phone: 3. 4. 5. Other (specify): 6. 7, 8. 9. ^7a meats, tamales, cooked beans, rice, Camp stove Double steamer Electric stove top Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) Approved water 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 water source. I O Other (specify);____________________ Electricity is provided for my booth’s use; Yes ISfNo Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All 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 to this event. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operatiom^Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F; The following is information about my organization/business: Name of organization/business: “P)! btC OlfcQ Hrifi ProvtdW Svn;ef l .. Alternate: ( )_____ List food to be sold or given to the public; , Lauai I am providing food that is NOT prepared at home:^ Yes No All food is prepared on-site or is from approved commercial facilities: YesQ No Name of facility: Phone: (^5/)) Address of facility: ^TTg Mb House, __ I am providing a booth with the foilowing: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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.