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TEMPORARY FOOD VENDOR’S APPLICATION Datel's)CfjSeyJ(o1. 2. Address: Phone: 3.List food to be sold or given to the public: 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. 7. 8. 9. Electric stove top Paqe 7 of 11EHD 16-02 P^pproved bofttetf water. On-site hose bib that is connected to a potable water source. Camp stove Double steamer Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids R All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. 1 Name of Even^-S^/] AZ ^533^ TEMP EVENT APP I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) lZj A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, complete,!)' enc,losing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation orotzic frnm tho r%i i hl if' »—<1 v-'i-A'-' II I i i U Iv'v< kJ 11 sy ■ Other (specify):______________________________________________ Electricity is provided for my booth's use: Tes No if I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: ^Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: SOther (specify) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. The following is information about my organization/business: Name of organization/business: __ . ( 7^7 ) Alternate: ( ) I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: [^Yes □ No Name of facility:Phone: ( ) Address of facility: .__________________________________ 22 35.“ pcoce'-tS our tv , S/IaJ Festival HEALTH meats, tamales, cooked beans, rice, 70 P.O.&jt 782 ZATh POp