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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.'. Narre of Evert <br />2. <br />Address: <br />Phone: <br />3 <br />4 <br />ifbi- <br />5 <br />pQ_pther fspecJfy); <br />5 <br /> Other {specify): <br />Electricity is provided for my booth's use <br />3 <br />9. <br />meats, tamales, cooked beans, rice, <br />HHC 1S-02 Pag* 7 of r TEVP =' A== <br />55f/» <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: The on / operations rot required to provice enclosed booths are those which sei beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />J^fsterno & hotel tra/s <br /> SJeam tab e & . ds <br />■STbther (speefy) <br />Neme cf organization cosiness: <br />C^Yes □ No <br />I am providing an accurate probe thermometer to measure the hot and cold bolding cf potentially hazardous <br />•’cods during all times of booth operation:\7j Yes O No <br />I am providing the follow ng hot temperature control for the hot holding of all potentially haza'dous foods above <br />135;F. <br />^Camp stove <br />lT Doub’e steamer <br /> Electric sieve top <br />Approved water for drinking, utensil and hard washing vri- be provided n my booth by the •'o.'lowing methods- <br />^^Aporo.-ed bottisd water <br />^On-site hose bib that is connected to a potabie water source <br />All mod vendors (both for profit and non-profit) are required to return a signed and completed copy o'this checklist to <br />the festival coordinator tnree (3) weeks orior to this event z> q <br />\^CAA-P JgZZ Date(s): <br />The following Is mformation about my organization/business: <br /> <br /> X 'r c/ <br />j) J ____________ ASsmate: ( ________ <br />List food to be sold or given to the public: CJ i 1?i Vi f , ft Pi k rZ)//5 <br />I am providing food tnat is NOT prepared at home: Yes No <br />All fcoo s prepared on-site or is from approved commercial facilities: j^Yes No . -. v <br />Name of facility: _____________Prone <br />Address' of facility wifehn, cpt ‘Kwz <br />I am providing a booth with -he following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) <br />J^Ta booth with walls and ceiling constructed cf either wood canvas, plastic, simfar mater ai and re mesh K-/ <br />screening, completely enclosing open food areas. It w li a so 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 />a-eas from the oubhe.