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REC1) <br />Date(s): 1.u <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice,Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> 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 />■ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br /> Sterno & hotel trays <br />0 Steam table & lids <br /> Other (specify) <br />MHCSDAll 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 />t.Name of Event <br />The following is information about my organ ization/business: <br />Name of organization/business: , VvYl <br />U)., CtovGC&l. <br />(Orfi } 83M " I Slo / I Alternate: ( )__________-___ <br /> List food to be sold or given to the public: HpV AffjS .S/UAg/jA (file,}; <br />I am providing food that is NOT prepared at home: H Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: Phone: () ... -------— ----- <br />Address of facility: —------------------------ <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 />IZTa booth with walls and celling 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 />Electricity is provided for my booth's use: Yes [yTNo <br />I am providing an accurate probe thermomqjter to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Ej Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135DF: <br />d Camp stove <br />O Double steamer <br /> Electric stove top <br />\(Y_________ <br />0|63W