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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 checklist to <br /> the festival coordinator three(3)weeks prior to this event J t <br /> Oate(s): f f <br /> I t Name of Event --"' <br /> i. <br /> 2 The following is information about my organization/business. <br /> Name of organaation;business. !' (� <br /> Address- t'�%�� L��I`',�"t�f (.tJ +.'�.�%fI C of-1i c.1{�'c-•�c,7Z'/1� �� �5�� � — �i <br /> Phone Alternate. ( ) <br /> t <`�j }� �S � rrLL,�^ (� <br /> 3 List food to be sold or given to the public. � <br /> �•` � Ut e Si r fJLS IC 9 `S- <br /> 4 1 am providing food that is NOT prepared at home: Yes❑ No <br /> Alt food is prepared on-site or is from approved commercial facilities: B'S'es❑No <br /> Name of facility: % ; , Coir'e, (C.� Phone:�2`�! 1 9J <br /> Address of facility: 3SI AVS <br /> 5. 1 am providing a booth with the following. (to protect my unpackaged food and food-preparation areas from flies, <br /> dust d 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): <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 /> ff 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 LSO <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: Q Yes❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1350 <br /> Camp stove ❑ Sterno & hotel trays <br /> Y <br /> ❑Double steamer ❑ Steam table & lids <br /> ❑Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, ric+; <br /> vegetables, potato salad, eggs, and dairy products. <br /> �HO <br /> tfi•+02 page 7 of 11 <br /> OV0Ifir IV%Al'I 1 N <br />