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i <br /> i <br /> I <br /> I <br /> EMPORARY POO® VENDOR'S APPLICATION <br /> { <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 "TAtf '5_Iz�'G1'�- W1 A 0- Date(s):Date(s): 9 1'9# f <br /> 2 The following is information about my organwatioNbusiness <br /> Name of organ izationlbusiness. 16r7ft'LF Cot <br /> Address 3Sa "*j t �. MlbV Vt-VA>vl ti0y5E C A G?I <br /> Phone- Alternate- ( ) <br /> 3 List food to be sold or given to the public: 'KtTLt Ct?VI-nJ Dn.)A" Tuynfti cAVX <br /> 4 1 am providing food that is NOT prepared at home: 7 <br /> tKes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes❑ No <br /> Name of facility: Ix Pu&Nc-1 E I S 'llCCir Lf U V-r _ .--Phone- (666 ) 4q;D • +q 4� <br /> Address of facility:3Sa. Q COLWAYLA9V CT, 07YI W14U5E cA -)x3111 <br /> 5. 1 am providing a booth with the following. (to protect my unpackaged food and food--pfeparation areas from flies, <br /> dust and the public) <br /> P-Abooth 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): <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 /> 5 Approved water for 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 g`Yes❑ No <br /> 8. lam providing an accurate probe thefmometef measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: es ❑ No <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 stove ❑ Sterno& hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑ 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 15-02 �acc 7 of'1 —EMP EVENT APP <br /> 081011.6 <br /> al <br />