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TEMPORARY FOOD VENDOR’S APPLICATION I.Name of Event:1. 2. Address: Phone: 3. 4. 7^ 5. 6. Other (specify): 7. the hot and cold holding of potentially hazardous 8. 9. vegetables, potato salad, eggs, and dairy products. TEMP EVENT APPPage 7 of 11EHD 16-02 8/1/14 Sterno & hotel trays Steam table & lids Other (specify) Other (specify):------------------------------- -------------------- -------------------- only operations not required to provide enclosed booths All food vendors (both for profit and non-profit) are the festival coordinator three (3) weeks prior to this event. Q Camp stove Q Double steamer Electric stove top Note: Examples of potentially hazardous food include: screening, completely enclosing open food asphalt, clean tarps and smooth wood are < areas from 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. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Approved bottled water. On-site hose bib that is connected to a potable water source. required to return a signed and completed copy of this checklist to nata(s(2jS/g ^Yes No Phone: ( A Electricity is provided for my booth's use?® Yes □ No I am providing an accurate probe thermometer to measure foods during all times of booth operation:® Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: meats, tamales, cooked beans, rice, The following is information about my organizationTbusiness: Name of organization/business: - locfeturd Meat and ------- Alternate: 7G List food to be sold or given to the public: I am providing food that is NOT prepared at home:^ Yes No All food is prepared on-site or is4rom approved commercial facilities: QfYes No Name of facility: Address of facility:/^ — I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) "Fl A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly CJ A boom wiin wans ana ce y ^eas ,t wjll a)s0 have a smooth and cleanable floor (concrete, acceptable) and constructed to separate food and food preparation