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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 ins ct ecM Est to <br /> the festival coordinator three(3)weeks pnor to this event <br /> t 1 Name of Event Date(s)- '�, law <br /> � <br /> 2. fhe following is information about my organizationlbusiness <br /> Name of organizahon/business <br /> Address 444(P (,t(� <br /> Phone' { 1 V(i"S Z Alternate <br /> 3 List food to be Sold or given to the public i I (1 t(�� riS h1 Y(3(,P Vl lA�Y tlr <br /> 4 1 am providing food that is NOT prepared at home [ Yes No <br /> All food is prepared o s oris from appro ed commercial facilities Yes❑No rJ ��g <br /> Name of facility Phone, (tj �`, tilt ttQ <br /> Address of facility <br /> 5 I 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 mesh fly <br /> Greening. 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 /> ❑Cther(specify) <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged tools from approved sources <br /> 6 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 /> 7]Other(specify) <br /> 7 Electricity is provided for my booth's use Yes[]No <br /> g, 1 am providing an accurate probe thermom5er to measure the hot and cold holding of potentially hazardous <br /> ¢; foods during all times of booth operation �g Yes 0 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 ot ntallyeghazardous gs,and dairy p include: meats, tamales, cooked beans, rice. <br /> vegetables,potato <br /> ts <br /> TEMO EVEN'•l�'F <br /> Pipe T a+'i <br />