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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event:Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />7. <br />8.to measure the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <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 />are required to return a signed and completed copy of this checklist to <br />Electricity is provided for my booth's use: Yes ETNo <br />EHD 16-02 <br />08/01/16 <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />i=RUIT YEGG/E FEZ F <br />I am providing an accurate probe thermometer to measi <br />foods during all times of booth operation: 0Yes No <br />The following is information about my organization/business: <br />Name of organization/business: C- P UB LIQs / PA' L~[ Li <S1 (PELSP <br />IG>OI E.HAFEL7FFJ C15205 <br />aoq) ^0-^3Cp8 Alternate: <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility:Phone: (1 <br />Address of facility: <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 />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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above