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TEMPORARY FOOD VENDOR’S APPLSCAT5ON <br />i. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />tj Other (specify): <br />7. <br />8. <br />9. <br />meats, tamaies, cooked beans, rice, <br />Page 7ol 11 TEMP EVENT APP <br />All food is prepared on-site or is from approve^ commercial facilities: <br />Lz-vx __i <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 />Name of facility: I <br />Address of facility:, <br />0:Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />v <br />Electricity is provided for my booth’s usez^fves Q No <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />EHD 16-02 <br />7/28(10 <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event: <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: D-Yes O No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />■^Approved bottled water. <br />fe'/pn-site hose bib that is connected to a potable water source. <br />\ <br />QVqsQNo <br />_ Phone: <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 following is information about my organization/business: <br />Name of organization/business: <br />Address: J <br />Phone: Alternate: ( <br />lust food to be sold or given to the public: VAW 0 <br />Ws V| ZG <br />I am providing food that is NOT prepared at home: [pzYes O No <br />ed onrsiie or is from approved commercial facilities: L <br />i <br /> <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 />I0A 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 cieanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public.