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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address:7 <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br /> Approved bottled water. <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 /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: The only operations not required to provide enclosed booths are <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Date(s): <br />I am providing food that is NOT prepared at home: j^Yes O No <br />All food is prepared on-site or is from approved commercial facilities: Dd Yes O 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 fiom flies, <br />dust and the public) <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 tarps and smooth wood are acceptable) and constructed to separate food and food pieparation <br />areas from the public. <br /> B Other (specify): SSIO I (C.ZZl---------------------------------------------------------- <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 />I.Name of Event: <br />The following is information about my organization/business: <br />Name of organization/business: "TcKi SkiqiaJ <br />Address: 5? 50 (AJ. Cy(X. to '\A_JC-l I, /d —L// ( CA. <br />(^6'9 ) tfr'l (y “I> y Alternate: ( )---- <br />List food to be sold or given to the public: Z/rx cA I Am UC <br /> On-site hose bib that is connected to a potable water source. f <br />W Other (specify): kJ ° - <br />Electricity is provided for my booth’s use: [S Yes □ No (/J l H f" I 1 I <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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: