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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />Other (specify): <br />6. <br />( 1 Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing an accurate probe thermomej <br />foods during all limes of booth operation: [, <br /> Camp stove <br />IZJ Double steamer <br />Fl Electric stove top <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by the following methods; <br /> Approved bottled water. <br />BTOn-site hose bib that is connected to a potable water source. <br />All food vendors (both for profit and non-profit) aro required to return a signed and completed copy of this checklist to <br />Date(s): <br />EHD 16-02 <br />7/14/15 <br />are those which sell beverages from <br />sources. <br />I J 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 cloanable floor (concrete <br />asphalt, clean tarps and smooth wood aro acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> <br />Note; The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />*135 F“. <br /> Sterno & hotel trays <br />IVf Steam table & lids <br /> Other (specify) <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 />Electricity is provided for my booth's use: [ZfYes No <br />ncJe!‘ *° measure the hot and cold holding of potentially hazardous <br />E/l Yes No <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: <br />1 ho following is information about my organization/business: <br />Name of organlzation/business: Svss?x5 j <br />Address: n I /Tidm , ftn ^~75 <br />Phone: (55 ^.Alternate^ ). <br />List food to be sold or given to the public: 9)0 0. WLtyiW <br />I am providing food that is NOT prepared at home: S'Yes No <br />All food is prepared on-silc oris from approved commercial facilities: [i^Yes No <br />Name of facility: Phone: ( ) <br />Address of facility: _