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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 chemist to <br /> the festival coordinator three(3)weeks prior to this event <br /> I.Name:of Event _ +o�K ;mot r k e-ir ©ate(s): <br /> 2. The followng is ii fomtation about myorgantzsdori/business: <br /> Name of organization/business: MG <br /> Address: I9 1-4 >40el roc;4i Ater- (:�OS4-a _441Csa <br /> Phone: 0 Alternate: <br /> 3, List food to be sold or given to the public: 14oi- 54 i/_C <br /> Pin�nnt� l�aha►zc <br /> 4. l am providing food that is NOT prepared at horse: 0 Yes 0 No <br /> AM food is prepared on-site or is from approved commercial facilities: 0 Yes Q No <br /> Name of facility: Phone: fYYq ) 4 Jf - <br /> Address of fatal r-74 irt/s : H� 4= ,� �� 44 <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparatim 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 /> El Other(specify): V n Z 14 a 5'4 <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 foir drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> []Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): - <br /> 7. Electricity is provided for my booth's use: ❑Yes 0 No <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: ❑Yes 0 No <br /> 9. 1 am providing the.follovwing hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> 0 Camp stove Q Stemo& hotel trays <br /> 0 Double steamer Q Steam table&lids <br /> d EL*&ic stove top 0 C,>ther(specify) <br /> _,j__ �_�_�.... * . .,fertlsNv hA"rdntis food Include. meats, tamales, cooked Deans, rice, <br />