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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:a :( Date(s). i v =—y---- <br /> 2. The followng is information about my organization/business— <br /> Name of organization/business: <br /> Address: t- <br /> Phone: ( 'Z+ 9 ) 4) Alternate:( 9 )4 -7 <br /> 3. List food to be sold or given to the public: ri f•fi A i 1_ ezAllrj <br /> 4. 1 am providing food that is NOT prepared at home: L I yes C!No <br /> All food is prepared on-site or is from approved commercial facilities: R Yes 0 No <br /> Name of facility '� � ► - � +s� Phone:(. 9) 2 C�: l <br /> Address of facility:77 6t�i <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 /> booth with walls and ceiling constructed of either wood, canvas,plastic,similar material and fine rnesh 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 /> ©Other(speccify): <br /> Note: The only operations not required to provide enclose Moths 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 /> [BIA-pproved bottled water. <br /> r_1 On-site hose bib that is connected to a potable water source. <br /> F1 Other(specify): <br /> 7. Electricity is provided for my booth's use:0 Yes 940 <br /> 8. 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: Q Yes[9�1515-,. <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑Camp stave 0 Stern&hotel trays <br /> ❑Double steamer fl Steam table&lids <br /> p Electric stove top C Other(specify) <br /> Note; Examples of potentially hazardous fond include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products, <br /> =wn tr na Pawn 7 of s i TEMP EVSNT APP <br />