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TIONRY FOOD VENDOR’S APPLITEMPO <br />Date<s) 1 Na^e of Event1 <br />2 <br />Address <br />3 <br />4 <br />) <br />5 <br />mses <br />6 <br />7 <br />8 <br />9 <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPP»g«7oMlEMO 16-02 <br />060V16 <br /> Stemo & hotel trays <br /> Ste^m table & lids <br />(speedy) <br />Name of organizabon/busmess <br />ZZ¥/ <br />Q Approved bottled water <br /> On-site hose bib that is connected to a potable water source <br />(3jXther (specify) <br />I . Yes IJMo <br />Phone i___ <br /><^’5/ <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note. Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />A!1 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) wee*s prior to thrs event <br />'Tra __ <br />The following is information about my organ-zatiorVt^iness <br />Ai-' <br />Phone l I Xz/ ' iAAAA Alternate <br />List food to be sold or grven to the public (------------ - ------ <br />Electricity is provided for my booth’s use Yes <br />I am providing an accurate probe thermometep^ measure the hot and cold holding of potentially hazardous <br />foods dunng all times of booth operation 3^es O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F <br />I am providing food that is NOT prepared at home ^\No <br />All food is prepared on-site or is from approved commercial facilities <br />Name of facility _______ <br /> Address of facility--------------------- ----- -------------------------------------- <br />I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the pubic) <br /> A booth with walls and ceihng constructed of e.ther wood, canvas plastc. similar matenal and fine mesh fly <br />screemng completely enclosing open food areas It will also have a smooth and cleanable <br />asphalt, clean tarps and smooth wood are acceptabe) and constructed to separate food and food preparation <br />areas from the pubic <br />[^Other (specify) <br />Note: The only operatons'not requ^ed to prov.de enclosed booths are those which sell beverages from <br />approved dispensers or prepackaged foods from approved sources <br />Approved water for drinking utensil and hand wasn.ng will be provided in my booth by the following methods