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TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2 <br />Address: <br />)Phone: <br />3 7 <br />4. <br />5. <br /> Other (specify)- <br />Approved /Alter for drinking, utensJ and hand washing will be provided in my booth by the folicnving methods6 <br />~ L->A~pnro'/ed beetled water <br /> On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9 <br />meats, tamales, cooked beans, rice. <br />1 IMP LVENT AFPPuyw 7 11 <br />n Camp stove <br /> Ooub-'e steamer <br />Q Electric stove top <br />Note: The only operations not required to provide enclosed booths are those which sell beverages *rom <br />approved dispensers, or prepackaged foods from approved sources <br />[_] Stereo & hotel trays <br />O Steam table & Ws <br />C Otner (specify) <br />eno iiw <br />itttu'.a <br />List food to be sold or grven to the public <br />I am provid-ng a booth with the foBowing (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />O Other (specify ):________________ <br />Electricity is provided for my booth's use: YesJ^JlMo <br />{j A booth with walls and ceding constructed of either wood, canvas, plastic, simdar mafenai and fine mesh fly <br />screening, completely enclosing open food areas It will also have a smooth and cleanaWe floor (concrete <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of aS potentially hazardous foods above <br />135’F <br />I am providing food that is NQT prepared at home: Q Yes-tj Mo <br />All food rs prepared on-site or is from approved commercial facilities Q Yes O No <br />Name of facility:Phone: ( ) <br />Address of facility: ______________________ <br />All food vendors (both for profit and non-proffl) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. / X) / j <br />1.Name of Event: 1 OateCs). II 0120 n <br />The following is information about my organization/business: <br />Name of orgamzaftorMbusmess. _ . fiitu feeirtz <br /> Alternate ( <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^n Yes No