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TEMPORARY FOOD VENDOR’S APPLICATION <br /> Date(s): <br />1. <br />2. <br /> <br /> <br />Address: <br />Alternate: ( ) Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />Page 9 of 11 <br /> Camp stove <br />Q'Oouble steamer <br /> Electric stove top <br />I <br />0 Yes No <br />_Phone: J <br />- <br />I""/ <br />are required to return a signed and completed copy of this checklist to the festival <br />All food vendors (both for profit and non-profit) <br />coordinator three (3) weeks prior to this event. <br />1 .Name of Event:. <br />The following is information about my organization/business. s <br />Nameoforganization/business: 6 ———- <br />20^ 5 Tr /-jo <br /> Stemo & hotel trays <br /> Steam table & lids <br /> other(specify) <br />lnclude- ^ns. rfce, <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screeninq <br />completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and <br />smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. <br /> Other(specify):___icj) _____ft 1-4 (2 <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from aoorov h <br />dispensers, or prepackaged foods from approved sources. ~ ec <br />Approved water for drinking, utensil and hand washing will be provided inmybooth by the following methods- <br /> Approved bottled water. <br />S-0rf-site hose bib that is connected to a potable water source. <br /> Other(specify): C X '\ ( pJ- O <br />Electricity is provided for my booth’s use: Yes No <br />'fZs^ <br />1 a^Pr°vldin9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />^pc /-JO <br /> <br /> — <br />List food to be sold or given to the public: <br />I am providing food that is ^£I.prepared at home: O Yes [3 No <br />All food is prepared on-sjte oris from approved commercial facilities: <br />Name of facility: ( <br />Address of facility: .5" ~~F^ £1 (AZ (J ' <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public)