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ARY FOOD VENDOR’S APP®:ATIONTENIPk <br />I.Name of Event1. <br />2. <br />du <br />Address: <br />) <br />3. <br />4. <br />C4- <br />5. <br /> Other (speedy): <br />6. <br />[^[Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />7. <br />a. <br />Q. <br />meats, tamales, cooked beans, rice. <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <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 /> Other (specify): <br />Electricity is provided for my booth’s use: £1 Yes No <br /> Camp stove <br />Q Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br /> Steam table & lids <br />E Other (specify) 0 <br />^4- D , <br />Nets: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />I am providing food that is NOT prepared at home: @ Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: Phone: () 33>5 - 6 4 3 <br />Address of facility: 3 <^4- D. C4- *------------------------------- <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 />pg. A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely endosing 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 />anaas from the public. <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: G5 Yes 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 />i<v Date(3): /i/soh^ <br />The following is information about my organizatlon/business: ///<*? <br />Name of nrganizatian/business:“T")T/^ di/cAc- Pl <br />Phone: ("5^ ) >4^^ Alternate: ( <br />List food to be sold or given to the public: