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TEMPORARY FOOD VENDOR’S APPUCATEON <br />1. Name of Event:1. <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> Other (specify): <br />7.Electricity is provided for my booth's use: <br />8. <br />9. <br /> Electric stove top <br />Page 7 of 11EHD 16-02 <br /> C^mp stove <br />ESYDouble steamer <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />EfApproved botti’ea' water. <br />0 On-site hose bib that is connected to a potable water source. <br />A <br />I^Yes No <br />7F NUcd if <br />I am providing an accurate probe thermometef to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Bves No <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />CP/? /I/ /fe7tAbatefs):C^7/^^77-/^ <br />cl4o‘+ll- <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />•^3^^ process <br />sMe. OTrr ro _ — <br />3/)/v isctPqiMN Tdtuak re&TiVAL <br />meats, tamales, cooked beans, rice, <br />zap tempeventapp <br />The following is information about my organization/business: <br />Name of organization/business: ^*6 <br />Address: <£.<2.7 'Z^Tek TD# <br />(45Z) ) ^3/-^ Alternate: ( ) <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: Sves No <br />All food is prepared on-site or is from approved commercial facilities: Hi es No <br />Name of facility: C Phone: ( <br />Address of facility:SthfyAfij, S'f. <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 />Q'A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, compieteiy 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 />frpm tho mihljr''Ui i i i i i Li iv v4 i i . <br />oP mS ic <br />$ <br />x