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TEMPORARY FOOD VENDOR’S APPLICATION I 1.1. Name of Event: 2. Address: Phone: List food to be sold or given to the public: 3. 4. 5. Other (specify): Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 of 11EHD 16-02 7/28/10 Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Sterno & hotel trays Steam table & lids Other (specify) jXl Approved bottled water. On-site hose bib that is connected to a potable water source. IL/Oi Name of facility: ______________ Address of facility: Name of organization/business: ~ ^,02^/ Alternate: (2^1 ) The following is information about my organization/business: jH Camp stove Double steamer £3 Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. M 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. Other (specify):______________________________________________________________ Electricity is provided for my booth’s use: Yes No I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: jS Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: I am providing food that is NOT prepared at home: Yes No All food is prepared on-site or is from approved commercial facilities: Yes No Name of facility: F/Ckm.fZ5 Phone: (Z^i ) I am providing a booth with the following: (tmprotect my unpackaged food and food-preparation areas from flies, dust and the public) 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. I I Date(s)- | I I <3 ffchfv milk- Ivalfh I) __________ - ^0^ 7 i