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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4, <br />5. <br />0. <br /> On-site hose bib that Is connected to a potable water source. <br />7.No <br />S. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page T of 1 x TEMP EVENT APP <br />Nate: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water tor drinking, utensil and hand washing will be provided in my booth by the following methods: <br />O Approved bottled water. <br />Ca other (specify); <br />Electricity Is provided for my booth's use: Yes <br /> sjemo & hotel trays <br />HTsteam table & lids <br />C Other (specify) <br />measure the ho* and cold holding of potentially hazardous <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />ISS’F: <br /> A booth with walls and celling constructed of either wood, canvas, plastic, similar material and fine mesh Ry <br />screening, completely enclosing open food areas. It wilt also have a smooth and cleanabla floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food end food preparation <br />areas from the public. <br />HfOttier (specify): ffashcllb 'iMd llihrl' ______________________ <br />Note: The only operations not required to provide enclosed booths are those which soil beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />eho <br />t7M/15 <br /> <br />ffu .faoc( J^e ; <br />................... “ - <br />I am providing an accurate probe therrnometerio mr <br />foods during all times of booth operation: Qyss O <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 ttiis event. <br />t.Name of Event: <br /> wo <br />______ Phone: ^i Q <br />ST- <br />I am providing a booth with the following: (to protect my unpeekaged food and food-preparation areas from flies, <br />dust and the public) <br />The following Is irtfarmatton about my organizaiion/business: <br />Name of organization/business: ' 'c-' . <br />5^ -573 7 Alternate: ( ) <br />List food to bs sold or given to Ihe public: 5 ti S&et$^e. <br />I am providing food that Is NOT prepared at homo: EfYes O No <br />All food is prepared on-site or Is from approved commercial facilities: <br />Name of facility: Ceyrr-erftCicj <br />Address of facility: /'Tf ~T 5^, U,Aj ;znfo 5 <br /> Camp stove <br />(Sfoocibls steamer <br />O Electric stove lop