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PAGE 02913b..j0599613:2907/17/2017 TEMPORARY FOOD VENDOR’S APPLICATION 1.Date(s): 2. 4- Phone: 3.List food to be sold or given to the public:+ 4. 5. Approved waler for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. 7. 8. 9. meats, tamales, cooked beans, rice, Paga 7 of 11 TEMP EVENT APP Camp stove Double steamer Electric stove top I am providing a booth with the following (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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 CJ'&eam table & lids Other (specify) EMO 16-02 08/01/16 Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control tor the hot holding of all potentially hazardous foods above 135°F: 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. j J YV ca K k—Date(s): I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation; [v}Ves No 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): L ______________________________________ 1 Name of Event: MuSlf Alternate: ( ) I am providing food that is NOT prepared at home: EfYes No All food is prepared on-site or is from approved commercial facilities; No Name of facility: Phone: (1 Address of facility: /^A o de L ■A On-site hose bib that is connected to a potable water source. Other (specify): 3 Electricity is provided for my booth's use: Yes No The following is Information about my organization/business. Name of organization/business: Idv ‘d) Address; 35^^ Ji Cl