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ATIONFOOD VENDOR’S ARALTEMPOF <br />'EM1 Name of I vent1 ( <br />•) <br />U-Addtess <br />Phone ) <br />Phone. ) 7 / <br /> Other (specify) <br /> On site hose bib that is connected to a potable water source <br /> Other (specify) <br />Electricity is provided for my booth's use Yes No <br />'j <br />meats, tamales, cooked beans, rice, <br />rFMf <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers or piepackaged foods from approved sources <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods <br /> Approved bottled water <br />Q ( amp stove <br />l~~l Double steamer <br />EJ I lectric stovi'top <br />Q fileino K hotel trays <br /> Steam table A lids <br />I I Other (spec ify) <br />I am providing an accurate probe thermometer to measure (tie trot and cold holding of potentially hazardous <br />' exjs during all times of booth operation Yes No <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing tin lollowing hot lemperatun1 control for ttre trot holding of all potentially hazardous foods ibovo <br />I lb I <br />1 HD 16 02 <br />i- li. <br />The following is information about my organization/business <br />li I- <br />All food vendors (both for piofil and non profit) art' required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior Io Ibis event <br />I am providing a booth with the following (to protect my unpackaged food and food preparation areas from flies <br />dusl'bnd the public) <br />0 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 />l am providing food that is NOT prepared at home IzfYes No <br />An food is prepared on site or is from approved commercial facilities Yes No <br />Name of facility H <br />Address of facility <br />FVCNT Afi' <br />« r\, // C C, V <br />. •... <br />l ist food to be sold or given to the public <br />Name ot.organization business <br />I ’ i< n> / ul II <br />Date(s) ~ <br />I ? <br />Alternate ( ) <br />p ■ bl, <br />I I