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J <br /> 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))wweeks prior <br /> �tothis event. <br /> 1. 1.Name of Event: IQ,1 (JI X�r(1wV 1C—�� Date(s): (0 <br /> 2. The following is information about my organ ization/business: <br /> Name of organization/business: A-rA ev 67 <br /> Address: 1 4��nll V/;F1W G6 r <br /> Phone: ale/ Alternate: <br /> 3. List food to be sold or given to the public: /—,(/�yioc, _ltrec, C C`C <br /> 4. 1 am providing food that is NOT prepared at home: �s❑No <br /> All food is prepared o�j-site or is from approved commercial facilities: VeYes❑ No <br /> Name of facility: /- X4 L/� �`� r%Zf'��� Phone: <br /> Address of facility: eL I-- <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 /> 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 /> pproved 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 KP61 <br /> 8. I am providing an accurate probe thermometer t easure 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 /> amp stoveerno&hotel trays <br /> ❑ Double steamer F9 Steam table&lids <br /> N,ffflectric 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 16-02 Page 7 of 11 TEMP EVENT APP <br /> 7114/15 <br />