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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APPEHD 16-02 <br />11/4/14 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />t^^Approved bottled water. <br /> On-site hose bib that is connected to a potable wtiter source. <br /> Stemo & hotel trays <br />[^Steam table & lids <br /> Other (specify) <br /> Other (specify): <br />Electricity is provided for my booth’s use:^ Yes iX’ <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 /> 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 />S^pther (specify): H O _____ <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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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: 3 Yes No <br />The following is Information about my organization/buslness: <br />Name of organization/business: yd-Oaten <br />7^1^13 __ Alternate: fl I lv ^13.31 S'o <br />I am providing food that Is NOT prepared at home: es No <br />All food is prepared on-site or is from approved commercial facilities: ^Yes Q No <br />Name of facility: HCXJ Q | Phone: ( ) __________ <br />Address of facility:__ _________________ _____________ <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. i / <br />Sto c /c t o Q? t Date(s); ■