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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event: Date(s). 1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />Other (specify): <br />7. <br />8. <br />9 <br />/A <br />meats, tamales, cooked beans, rice, <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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) <br /> Sterno & hotel trays <br /> Steam table & lids <br />0 Other (specify) <br /> 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 />Other (specify): __ <br />(/ <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 />Name of organization/business: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />/-f J"/ <br />/7- ? 9 <br />The following is information about my organization/business: <br /> Alternate: ( <br />List food to be sold or given to the public: / 7 4^2^0 <>4^ <br />I am providing food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: [P] Yes No <br />Name of facility: ^7 Phone: (Xj&) 2. <br />Address of facility:. I "T 0 <br />> <br /> On-site hose bib that is connected to a potable water source. <br />L0 Other (specify): T/ <br />Electricity is provided for my booth’s use: Yes 0No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: EJ Yes No T/ <?( - <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: