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All foOd vendors (both for profit and r profit) are required to return a si<(►pd +f 4 VWM or /4 ,, WW fer the festival coordinator three (3) week . ;for to this event. 1. 1.Name of Event: 2. The following is information about my organization/business: r Name of organization/business: Address: %C�`� <J i/,��j, !� �-1✓ �r `�:..L'/ Phone: ( ) '-7 3. List food to be sold or given to the public: ."le' 4. 1 am providing food that is NOT prepared at home: ❑ No All food is prepared on-site or is from approved commercial facilities: eryes E)110 Name of facility: it Address of facility 5. 1 am providing a booth with the following: (to protect my unpac aged Rxd arW 0(wo 1 , dust and the public) ❑ A booth with walls and ceiling constructed of either wood, canvas, rr rrj fib r -i fly screening, completely enclosing open food areas. It will also have a sroo and o, rr x Fr, ►{ . asphalt, clean tarps and smooth wood are acceptable) and corstruc Led to �W,VM acid Av,4 G tWatteA areas from the public. [Other(specify): eel Note: The only operations not required to provide enclosed # are ,x t blow from approved dispensers, or prepackaged foods from approved swam. 6. Approved water for drinking, utensil and hand washing will be prokled in my Ix. ►try It* w" tr*fty)ds El-Approved bottled water. ❑ On-site hose bib that is connected to a potable water source ❑ Other(specify): 7. Electricity is provided for my booth's use: ❑ Yes No 3. 1 am providing an accurate probe thermometer to measure the hot aid end Wd" Cit lam/ 1337-NdOM foods during all times of booth operation: ❑ Yes ffNo i. I am providing the following hot temperature control for the hot hofdirg of aN poterdi0y baZaOCAA fob abovoe 135°F: ❑ Camp stove ❑ Sterno & hotel trays ❑ Double steamer ❑ Steam table & lids ❑ Electric stove top (Other(specify) Note: Examples of potentially hazardous food Include: MOO", tales, aodied bOSM, 11C*+ vegetables, potato salad, eggs, and dairy products.