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TEMPORARY FOOD VENDOR'S APPUCATKON <br /> All food ven&rs(toth ti:1r p"it and neii-1wom)are required to return a aigrrKJ"arOMP45W oapy of q*r W'"bt to <br /> the festivat cxKwdlnator thffae(3)wesfcs prior to this event. <br /> x 1 <br /> 1 1.NEfm<:Of trvent <br /> 2 1he foliovnng ie info,-matiors aboi it my <br /> Nsafrea - <br /> �71 <br /> Phone: (l A Y1 ,J M�L f . <br /> 3, List food to be sold or gm-mi to the public s rt t f ,mot.,< -. /n 11L•� �— r�c)!�"Cj- <br /> 4. 1 am providing food that is riQF prepared at horse:I+' Yes 0 No <br /> All food is prepared oo-trite or is from approvers oommerrJal feal'rtles: 1"0'Yes❑No <br /> lti Phone:(2-eq) <br /> Name of facility! _ �'- .�- > � - - <br /> Address of fecality: _� �l .x '11 c, ..-_--- <br /> 5 1 dm providing a booth with the fallowing: (to protect my unpackaged food and food-preparation areas from flies. <br /> dust and the public) <br /> t wood, canvas,plastic similar malerral and fine mesh fly <br /> s e-ening, corrpiately enclosing open food areas. it will also have a smooth and cleanable floor (concreto, <br /> A booth with wags and ceiling oonstructed of either <br /> r <br /> asphalt, clean tarps and smooth wood are acceptable) and oonstructed to separate food and food preparation <br /> areas from the public. <br /> Lid Other(specify) <br /> Note: The only opefations not requifed to provide enclosed booths are those which Bed beverages fmm <br /> approved dlspansefs,or prepaaap;od foods from approved sour. <br /> 6 A4Mmved water for drinking,utensil and hand washing will be provkled in my booth by the fcNiowing methcxis. <br /> ❑Appruved bottled water. <br /> ❑on-site hmo bib that is connected to a potable Water source <br /> 0"other(specify) <br /> 7. Electrfc3ty is provided for my booth's use':❑Yes[v_f✓N. <br /> a. I ern providing an accurate probe thermometer to�m yore thn hot and cold nodding of potentially hazardous <br /> foods during all times of booth operation. ❑Yes L+t No fW •TC.s •�,.,�(f <br /> g, 1 am providing the following hot temperature control for the hot holding of all potentlalty hazardt3us toads above <br /> 135°F: <br /> �j camp gbrn ' F1 st�rr,o 8 betel treys <br /> ❑poube steamer ❑/Steam table&lids <br /> Ll F-iectric stove top LVCither(NWIfy) n] <br /> NoW Examples of potontiartly hazardous food include: Meats, trrrnales, cooked b*anu, rice, <br /> vag,,Ubtes,potato sated,eggs,and dalry products. <br /> Tf61P EVFN7 APP <br /> EHA 16-M <br /> 712@v10 <br />