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1.Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />) <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />) <br />8u <br />- ^3^4 <br />EHD 16-02 <br />AR/m/1A <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies <br />dust and the public) j <br />E3 A booth with walls dnd ceiling constructed of cither 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 />TEMPORARY FOOD VENDOR’S APPLICATION <br />weo™Xotfe '° <* "* *«"“ <° <br />1 Name of Event: PfeR I5LAN05 CFH Date(s): ** Ofly S <br />The following is information about my organization/business: <br />Name of organization/business: <br />Address: PO |l2>OX >^<24*14 STc^C C <4 <br />(<c " ')I QI S 4 Alternate: ( <br />List food to be sold or given to the public: f p f fvJ. <br />I am providing food thatj is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Q Yes No <br />Name of facility: ■_________________Phone: ( <br />Address of facility: I <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />0 Approved bottled we ter. <br /> On-site hose bib theft is connected to a potable water source. <br /> Other (specify): I_____________ <br />Electricity is provided fcr my booth’s use: 0 Yes No <br />I am providing an acciirate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times|of booth operation: Q Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />*135 F. <br />cf Camp stove I Sterno & hotel trays <br /> Double steamer i Steam table & lids <br /> Electric stove top ; Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.