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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): ^7 !() - lj-70/£1. <br />2. <br />Phone' <br />List food to be sold or given to the public:3. <br />4. <br />1 <br />5. <br />PusA.c /-yrrJCc* 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 /> Other (specify): <br />Electricity is provided for my booth’s use: Yes7.No <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 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: QYi <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 /> Sterno & hotel trays <br />0 Steam table & lids <br /> Other (specify) <br />measure the hot and cold holding of potentially hazardous <br /> No <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 /> 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 />AH 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 />1. Name of EventL?/?/)/ 77)/\ & (J Z7/ 7~A MAte- F7^T'(l/M <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <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 <br />Name of facility:Phone: i <br />Address of facility: <br />The following is information about my organization/business: f <br />Name of organization/business:^ A | U R— <br />Addres^ZS 07 Ca <br /> Alternate: ( ) <br />__GA^T__________________ <br />0