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All food vendors (both for profit and non-profit) <br />Dale(s): __L <br />1. <br />2. <br />3. <br />4, <br />5. <br />:: <br />6. <br />7, <br />8. <br />9. <br />Note: <br />TEMP EVENT APPPaflSZofl'i <br />I <br />EHD 18-02 <br />7/1 <1/15 <br /> Stemo & hotel trays <br />O Steam table & lids <br />0 Other (specify) <br />meats, tamales, cooked beans, rice, <br />i <br />i <br />j <br />I <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-) are required to return a signed and completed copy of this checklist to <br />(he festival coordinator three (3) weeks prior to this event. z ? <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <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 />0 Other (specify): ’’y "f t1 ------— --------------------------------—------- <br />Electricity is provided for my booth's use: Yes 0 No <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: ® Yes No <br />l am providing the rollowing hot temperature conW lor the hot holding of ell potentially tazardous foods aboya <br />135°F: <br />1. Name of Event: ----------------------- <br />The following is information about my organization/business: <br />Name of organization/business; i <br /> <br />Address: <br />Phone: -------------------------Alternate: (----------- <br />List food to be sold or gwen to the public: 5 - ‘ <br />I am providing foodjhat is NOT prepared at home: H"Yes No <br />Tdl food is prepared on-slt^or is from approved commercial facilities: ET Yes No <br />------tf-%7----------- ' • Phone: (____)---------------------- ---------------Name of facility:------------------------------------------------------ ------------ <br />Address of facility:.———------------------------—-------------------------- <br />[ am providing a booth with the foilowing: (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 ^esh Jy <br />areas from the public. x z, <br />0'Other (specify): A-' ------1 ---------fl —------------------------------- <br />only operations not required to provide enclosed booths