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TEMPORARY FOOD VENDOR’S APPLICATION I.Name of Event: 1. 2. Phone: 3. 4. 5. 6. 7. the hot and cold holding of potentially hazardous8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 of 11EHD 16-02 4rS'Sfemo & hotel trays Steam table & lids 0l5ther (specify) H^pproved bottled water. P-On-site hose bib that is connected to a potable water source. gather (specify):---------------------------------------------------------- Electricity is provided for my booth’s use: EZfYes O No screening, completely enclosing open food asphalt, clean tarps and smooth wood are < areas from the public. Brother (specify): Note: The only operations not required to provide enclosed booths ETCamp stove Double steamer Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. ; 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: I am providing an accurate probe thermometer to measure foods during all times of booth operation: 0Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Date(s): 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) weeks prior to this event. The following is information about my organization/business: Name of organization/business: ---------- Address: 6/7 (3^*^ Alternate: (---------------- - List food to be sold or given to the public: j I am providing food that is NOT prepared at home: ffl'Yes No All food is prepared on-site or is from approved commercial facilities: EfYes 0 No Name of facility: ------------------------------Phone, z - ---------------. Address of fanility: j6 IX I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) ETA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly ' 1 areas. It will also have a smooth and cleanable floor (concrete, acceptable) and constructed to separate food and food preparation