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( <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />3. <br />4. <br />). <br />5. <br />IlHKI WUUU, Udlivao, piuouu, -----------------------------------— <br />It will also have a smooth and cleanable floor (concrete, <br /> <br />6. <br />7. <br />the hot and cold holding of potentially hazardous <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APRPage 7 of 11EHD 16-02 <br />7/14/15 <br /> Other (specify):_ <br />only operations not required to provide enclosed booths <br />e <br />required to return a signed and completed copy of this checklist to <br />Oo. Raiv 20II? »»»2)b <br />All food vendors (both for profit and non-profit) are <br />the festival coordinator three (3) weeks prior to this event.^ <br />I.Name of Event: -------------------- <br />The following is information about my organization/business: , <br /> Name of organization/business: K] C DP----------------------—-------/ \ <br />Address^^ <br />Phone: Alternate: (Q |/2) ------------- <br />List food to be sold or given to the public: VVl.kX'A —1^?M 0 <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: j^Yes No <br />Name of facility:Phone. (----- <br />Address of facility:------------------------- -------------------------------- -------------------- <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 />Wa booth with walls and ceiling constructed of either wood, canvas, plastic, similar materialmesh fly <br />-d X^b^-and-cTnstmcted to separate food and food preparation <br />areas from 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />T^On-site hose bib that is connected to a potable water source. <br /> Other (specify): ______________ <br />Electricity is provided for my booth's use: ^Ves Q No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: N^Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: Wk. <br /> Campsto/e ' Sterno & hotel trays <br /> Double steamer O Steam table & lids <br /> Electric stove top Q Other (specify) <br />Note: Examples of potentially hazardous food include. <br />vegetables, potato salad, eggs, and dairy products.