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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br />6. <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />7/14/15 <br /> Camp stove <br />□>(5ouble steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Other (specify): <br />Note: The only operations not required to provide enclosed booths <br />)_________________ <br />. d h i li 7 (/ <br />I.Name of Event: X5 a n <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />ition/business: <br />n (\P Z? i O il ________________ <br />_______ Alternate: ( <br />prior t <br />M\0(b <br />The following is information about my organiztetion/busir <br />M 0 <br />T 1 ft.r 111 A <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 />[PfApproved bottled water. <br />QTOn-site hose bib that is connected to a potable water source. <br />Electricity is provided for my booth’s use: No <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: O' Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Name of organization/business: <br />Address: I J <br />List food to be sold or given to the public: Ct/Th <br />I am providing food that is NOT prepared at home: [XfYes O No <br />All food is preparec^omsitepr is from approved commercial facilities: [^fves □ 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 />[ 1 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 />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 pjjor to this event. ■ 7 / <br />llyt/)-! ( U4ft ~n4 1 li r Date(s)k