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TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />1. <br />2. <br />Address: <br />) <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />EHD 16-02 Paae 7 of 11 rri r-t <br />are those which sell beverages from <br />Date(s): <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: Yes No 1fc <br />Name of facility: _______________ _________________Phone; ( } <br />Address of facility:__ <br />All food vendors (both for profit and non-profit) are ‘ <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event:. San GxMh <br />The following is information about myorganization/business: <br />Name of organization/business: l^€'HlC']0Pl <br />2H45S-St c/h <br />Phone: (5^ Alternate: ( <br />List food to be sold or given to the public: <br />1 ad™s7and the public)1 f°ll0Wing: (t° protect my unPacka9ed food aad food-preparation areas from flies, <br />[3 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 />areasfrornTthe public3^ Sm°Oth W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify):___________________ <br />Note: The only operations not required to provide enclosed booths <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 /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: S Yes No <br />* pro,vlcJ.irig 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 />' a^_pL0Vid'ng the fol,ow»ng hot temperature control for the hot holding of all potentially hazardous foods above <br />130 r. <br />Q Camp stove QJ Sterno & hotel trays <br /> Double steamer steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.