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TEMPORARY FOOD VENDOR’S APPLICATION <br />Data(s): <br />2. <br />1 <br />3. <br />4. <br />5. <br />6. <br />! <br />9, <br />135’F: <br />meats, tamales, cooked beans, rice, <br />Pago 7 of 11 TEMI* EVENT AFP <br />l <br />f <br />¥ <br />EHO 16-02 <br />7/1*16 <br />QfCamp stove <br />Q-Oouble steamer <br /> Electric stove top <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. t.Name of Event: <br />The following Is Information about my organization/buslness: <br />Name of organization/buslness: <, <br />Address: <br />Phone: (>^ Alternate: ( i <br />List food to ba sold or given to the public: ^5 A. / <br />I am providing food that Is NOT prepared at home: BjS'es No <br />All food Is prepared on-site or Is from approved commercial facilities: OS'es O No <br />Name of facility: \Phone: <br />Address of facility: '' <br />( — ....................................................... - ■ • . ... ------------------------------------------------------------------------------------ <br />I am providing a booth with the following: (to protect my unpackaged food end food-preparation areas from flies, <br />dust and the public) <br />I^Abooth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh fiy <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood ere acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0'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 />[vfon-slte hose bib that Is connected to a potable water source. <br />□Other (specify):______________________ ________________________ <br />7. ElecMcity Is provided for my booth's use:f7fYes No <br />8. I am providing an accurate probe lhermorneter'to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes No <br />1 3™£Pr1?vldin9,he fo|low,n9 hot temperature control for the hot holding of all potentially hazardous foods above <br />Efstemo & hotel trays <br />O'steam table & lids <br />Brother (specify)