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TEMPORARY FOOD VENDOR’S APPLICATION <br />1 .Name of Event: . )C'4 ''A1. <br />2. <br />Address: <br />Phone: <br />S3. <br />4. <br />5 <br />5. <br /> Other(specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />Approved bottled water. <br />! | On-site hose bib that is connected to a potable water source. <br />j~| Other(specify): <br />7. <br />8. <br />9. <br />Page 9 of 11 <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 />Note: The only operations not required to provide enclosed booths are those which sell beverages from approved <br />dispensers, or prepackaged foods from approved sources. <br />[J Sterno & hotel trays <br />^^Steam table & lids <br /> other(specify) <br />Electricity is provided for my booth’s use^jfVes No <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: CJYes No <br />i | Camp stove <br />Double steamer <br />O Electric stove top <br />.[^Yes Q No <br />Phone japO*? ) <br />■{71 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, <br />ycofnpletely 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 />Alternate: ( ) <br />/cf £ <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />coordinator three (3) weeks priorto this event. <br />■2s d a i A <br />The following is information about my organization/business: . . <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival <br />^^22A_^L^sX±/ate(s):5^_Z2Z/ <br />Nameoforganization/business: \J ) Or <br />13 OS M i <br />3 ^^3 Q 0______ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Yes <br />All food is prepared on-site oris,from approved commercial facilities: <br />Name of facility: \J < i / <br />Address offacility: ) ~ cj <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.