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TEMPORARY FOOD VENDOR’S APPLICATION 1. Name of Event:1.Date(s): 2. Address: 3. 4. 5. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods:6. Approved bottled water. 7. 8. 9. meats, tamales, cooked beans, rice, Paga 7 of 11 TEMP EVENTAPPEHD 16-02 7/14/15 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh Uy screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrelo, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Other (specify): I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. [~] Stemo & hotel trays FT Steam table & lids O Other (specify) Camp udve / Doubk steamer Electric stdyeJefT Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. jmetei i:JZJ Yes No I am providing the/following hot temporaturo control for the hot holding of all potentially hazardous foods above 135°F: / / jzf Yes □ No _ Phone: (). On-site hose bib that is connected to a potable water source. Other (specify): __________________________________________ Electricity is provided for my booth's use:jzl Yes □ No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all limes of booth operation: fZJ Yes No All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) week&prior to this event . , fcSl Date(s): The following is Information about my organlzation/buslness: Name of organization/business: .SZ- Phone: ( ) ^ 2^7 Alternate: ( ) List food to be sold or given to the public: CofecL ip'—. I am providing food that is NOT prepared at home: CTYes No All food is proparfirfon-site^r Is from approved commercial facilities: Name of facility:_____________________________ Address of facility: