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DocuSign Envelope ID: A6E74685-DEDE-4900-90F6-8D6DC4F9DF9A TEMPORARY FOOD VENDOR'S APPLICATION All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3). weeks prior to this event. 1, 1.Name of Event. Kite Festival, July 4, Aug MIP,, Sept MIP 2. The following Is Information about my organization/business: Name of organIzation/business: 5(Ar..)uo Ye. A.),)-i Address: kA-;) N141-rAt..tti hr 011/14 Phone: (blic) 1474, —6 ci 3, List food to be sold or given to the public: 5 (itxtv I am providing food that Is figz prepared at home; 1.:2] Yes 0 No All food Is prepared on-site or is from approved commercial facilities; gi Yes EI No Name of facility: "" 0 Phone: ) Address of facility: I am providing a booth with the following; (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 7 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas, It will also have a smooth and cleanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. ID Other (specify): Cc) Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources, 6, Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: I ev:(0-041- Electrloity Is provided for my booth's use: ra Yes No .11,11_ w i )1 i) 044 I am providing an accurate probe thermometer to measure the hot and cold holding of potentially foods during all times of booth operation: E] Yes 0 No 9, I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: D Camp stove Double steamer EI Electric stove top. o Sterno & hotel trays Li Steam table & lids 0 Other (specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, vegetables, potato salad, eggs, and dairy products, 6 .e; .5'c'.!) '7 /S— Alternate; (6 ) 66 6 — 6 ci O Approved bottled water. E] On-site hose bib th El Other (specify): nnected to a p 5t.c 6 cmit-ti At.e,d water source. y f;LLI.,1 t'c.telif 6-1,7-4,8-17,9-24 , Date(s) rt. (.11= hazardous > EHO 16.02 Page"! of 1-1 TEMP EVENT APP MOM