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TEMPORARY FOOD VENDOR’S APPLICATION <br />i.I.Name of Event: <br />2. <br />Address: <br />Phono: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will bo provided in my booth by tho following methods:6. <br /> Ollier (specify): <br />Electricity is provided for my booth’s use:7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />ii <br />EHD 16 02 <br />7/14/15 <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: O Yes C5 <br />Name of facility:Phone: ( <br />Address of facility: <br /> 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 larps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />D TlZ-A'«cFc/C- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and tho 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 /> Camp stovo <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />measure lhe hot and cold holding of potentially hazardous <br />' 1 No <br />S-Approved bottled water. <br />[_J-Omsile hose bib that is connected to a potable water source. <br />I am providing the following hot temperature control for (he hot holding of all potentially hazardous foods above <br />135’F: <br />O Stemo & hotel trays <br />H^team table & lids <br />QlStfic r (specify) P J <br />'es 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 />Date(s): *^0^ <br />I am providing an accurate probe thermometerfe mt <br />foods during all limes of booth operation: I^Vcs O <br />Io <br />) <br />The following is information about my organization/business: • <br />Name of organization/business: <br />~~Gc, Ckuf t Ar^- ^^^>3 [ <br /> Alternate: ( ) <br />List food to be sold or given to the public:.