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TEMPORARY FOOD VENDOR'S APPLICATION <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 /> 1. 1.Name of Event: '-�CC..Y'�-.yy A - Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business:_L262UEtA ! " <br /> t ' <br /> Address: <br /> Phone: " Alternate: { ) <br /> 3. List food to be sold or given to the public: 4-VWj i I aL4A :-7 !CC- E `q� . . . <br /> 4. 1 am providing food that is NOT prepared at home-)Q Yes F. No <br /> All food is prepared on-site or is from approved commercial facilities:' Yes ED No <br /> Name of facility: Phone:{ } <br /> Address of facility: T <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> FA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> reeping, completely enclosing open food areas, it will also have a smooth and cleanable boor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> 0 Other(specify): <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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> P!fApproved bottled water. <br /> []On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> T Electricity is provided for my booth's use: ❑Yes in,No <br /> & 1 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 /> 9. 1 any providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer Steam table &lids <br /> Q Electric stove top ❑Other(specify) <br /> Taste: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br />