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/ 4 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event: <br />2. <br />Nameoforganization/business: <br />/eo Address: <br />6zs~/( ) ^^6Phone:Alternate: () <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />6. <br />5 <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9. <br />food include: meats, tamales, cooked beans, rice, <br />Page 9 of 11 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Q Sterno & hotel trays <br />[3 Steam table & lids <br />Q other(specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />Note: Examples of potentially hazardous f <br />vegetables, potato salad, eggs, and dairy products. <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 />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 />coordinatorthree (3) weeks prior to this event. <br />& zl zoiC <br />The following is information about my organization/business: <br />'Tift <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 />0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, <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):_____________ ____________________ <br />es No <br />_Phone: ( 2.0) 6T V - Z op c.1 <br />^-0 C At ^^3^0 <br />I am providing food that is NQLprepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: C A Ti A./sv<k S r ret- <br />Address of facility: S' K z 6 Aoy <br />Q On-site hose bib that is connected to a potable water source. <br />Other(specify): 5 f?" Uf <br />Electricity is provided for my booth’s use: ^/Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: /’/Z