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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7.Electricity is provided for my booth’s <br />8. <br />9. <br />Page 9 of 11 <br />I I On-site hose bib that is connected to a potable water source. <br /> Other(specify):______________________ <br />Q Camp stove <br />0 Double steamer <br />[J Electric stove top <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:^] Yes No <br />use: [^fves □ No <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 priorto this event. / <br />I.Name of Event:. WnAig.fe%\\iAt^_____ ______Date(s): <br />Thefollowing is information about myorganization/business: <br />Name of organization/business: <br />iW h. z7r. <br />Listfood to be sold or given to the public: TAMAdcftZ VQ^ITU.( I-^TTftflJUX. <br />I am providing food that is NQLprepared at home: 0 Yes No <br />All food is prepared omsite oris from approved commercial facilities: <br />Name of facility: <br />Address of facility:. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />(/fApproved bottled water. <br />1 a™ Por°vidiri9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />- - I. .. 0 Yes No <br />DOPA TO M A .. ___Phone: ( ZfjQ) L.->\'lao <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 />Q Other(specify):_________________________________ <br />0 Sterno & hotel trays <br />0 Steam table & lids <br />0other(specify) 0^ <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products.