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/ <br />1.Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />5. <br />(her (specify): <br />those which sell beverages from <br />6. <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />EJ Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />TEmAaRY FOOD VENDOR’S APiAaTION <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. Name of Event: <br />Qu <br />Alternate: ( )____________ <br />List food to be sold or given to the public:. liUjLjL id <br />I am providing food that is NOT prepared at home: Q^Ves No O' <br />i-^ite or is from approved commercial facilities: I^Yes No ' t / <br />_____________ Phone: <br />uJ. <br />I am providing a booth with the following: (to protect my unp&ckaged food and food-preparation from flies <br />dust and the public) <br /> A booth with walls and ceiling 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 />^j^Other (specify):. <br />Note: The only operations not required to provide enclosed booths are <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 />^sApproved bottled water. <br />^Kon-site hose bib that is connected to a potable water source. <br />pother (specify): <br />Electricity is provided for my booth’s use: Yes C^Jo <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />' Pr°vldln9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 Fl <br />All food is prepared onsite or is from approved commercial facilities: 0 Yes No <br />Name of facility: Phone: <br />Address of facility: z.^/ 6} / "T-S < <br />" 6(1^5'3 3 A <br />The following is information about my organization/business: <br />Name of organization/business:. /'AcAuUO / & <br />/^Wl> \jJ, jk/nmzx Im, <br />an ^ ^6_____