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TEMPORARY FOOD VENDOR'S APPLICATK]N All food vendors(both for profit and non-proftt)are required to return a signed and txxnpke copy of this checklist to the festival coordinator three(3)weeks prior to this event. 0-IaAA[c i. 1.Name of Event. S-,,,,,t. 1Lrw5+r,+} _ �r�+�Y�r� �G. ti _ ,._oatew i 2. The following is information about my organizatronlbusiness: r"ria,Al, C t.�6Name of or�ganizationibusiness: t K t uxt c�+s Address. Vo Phone: (,�LCAL ) '�Sg ' l 0 So I) Attemate:(7r,rt S a 3. List food to be sold or given to the public LA rv.�2)L<: US-1 l , n-�,) t � S71 p 4. l am psNiding food that is NOT prepared at home: 2/yes❑ No �" All food is prepared on-site or is from approved commercial facilities. Cr Yes❑No Name of facility: Cpy I t-�1 U>;I �� !�o f Phone:2L{�1 o C b Address of facility- I ( VV` L(7,iq 1Sr :kvc 1- 1-1�(<< a 5- l am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, dust and the public) R 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, dean tarps and smooth woad are acceptable) and constructed to separate food and food preparation areas from the public_ ❑Other(specfy): 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. Approved b ttled water. ❑On-site hose bib that is connected to a potable water source. ❑Other(specify): 7- Electricity is provider)for my booth's use:❑Yes 2 No 8. 1 am providing an accurate probe thermometer to�m�sure the hot and cold holding of potentially hazardous foods during all tunes of booth operation: ❑Yes VNC 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above i35'F: vi p, 0 camp stove L]Stoma& hotel trays ❑Double steamer ❑steam table S lids ❑ Electric stove top ❑Other(specify) Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rir_e, vegetables,potato salad,eggs,and dairy products. EHO 16W2 TEA!P EVENT APP 7?U 10