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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(bob)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.tthis,event. <br /> 1 f.Name of Event: T Z cW ~>j Date(s) <br /> 2 The following is information about my organization/business: <br /> Name of organization/business: V r1 <br /> Address: � 6� j5, bori --tE t L-b to,11 I5;- <br /> Phone: ( ) " 2-2-�3 Alternate:( ) <br /> 3. List food to be sold or given to the public: ` <br /> 4. 1 am providing food that is NOT prepared at home:%Yes No <br /> All food is prepared on-site or is from approved commercial facilities: { Yes❑No <br /> Name of facility: i�Ni7ftt- t�t.i I'�tT Phone: <br /> Address of facility: <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 /> ❑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 /> Other(specify): 6 d-hi <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 /> F4pproved 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 TZ 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:f4Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: ��1 <br /> []Camp stove ' f/ ❑Stemo&hotel trays <br /> Double steamer ❑steam table&lids <br /> ❑Electric stove top 0 Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables.potato salad.eggs,and dairy products. <br /> EHd 16"112 TEMP E VENT APP <br /> 7114115 <br />