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• I <br />TEMPORARY FOOD VENDOR’S APPUCATION <br />1. Name of Event: 1. <br />The following is information about my organization/business:2. <br />/ <br />Address: <br />Phone: <br />3. <br />4. <br />1 <br />5. <br /> Other (specify): <br />6. <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: Yes O No7. <br />3. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APRPage 7 of 11EHD 16-02 <br />7/14/15 <br />I am providing an accurate probe thermometer, <br />foods during all times of booth operation: S^Yi <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) <br />^Mmeasure the hot and cold holding of potentially hazardous <br />'es No <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br />[}3 Other (specify) (_Y'Vy <br />Name of organization/business:G <br />/ftp i rY. ha! <br />(2 o * 3 - 4 <br />List food to be sold or given to the public: i <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <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 />M 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 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 all potentially hazardous foods above <br />135°F: <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 />lML2al£> <br />__________ Alternate: ( ) <br />I am providing food that is NOT prepared at home: No <br />' All food is prepared on-site or is from approved commercial facilities: [TWes^Z] No <br />Name of facility: kJ / H_______________________Phone: £ <br />Address of facility:' ________________________________