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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. Name of Event:1. <br />2. <br />Address: <br />Phone: <br />List food to be sold or given to the public:3 ++ <br />4. <br />1 <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />■es NoElectricity is provided for my booth’s use"7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />I am providing food that is NOT prepared at home: <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: ____________________________________ <br />Address of facility: <br />Q-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 />areas from the public. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />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 />Q-Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />^Yes No <br />Phone: (___ <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Alternate: (^A f ) <br /> Approved bottled water. <br />ST On-site hose bib that is connected to a potable water source. <br /> Other (specify):_________________ <br />g,gt| - 173'1 <br />Tacos, (Ls <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:^] YesT~I No <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 />4W <br />The following is information about my organization/business: <br />Name of organization/business:. <br />t Zect1 ( <br />.^Yes No