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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s)1. 1. Name of Event: <br />2. <br />Address: <br />Phone: <br />3 <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />»ther (specify): <br />Electricity is provided for my booth's use:7 <br />3. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 cf 11 TEMP EVENT APP <br /> Camp stove <br />O Double steamer <br /> Electric stove top <br />rVStemio & hotel trays <br />EJ Steam table & lids <br /> Other (specify) <br />ed and completed copy of this checklist to <br />V-7-/^ <br />I am providing an accurate probe thermometefjo measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Er es O No <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 />=HD 15-02 <br />11,'4/14 <br />UkApproved bottled water. <br />Eon-site hose bib that is connected to a potable 'water source. <br />The following is information about my.organization/business: <br />■§na non-prdfitj^re required te <br />■^i>4Zl'rr7ti <br />All food vendors (both for pa <br />the festival coordinator three- <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T; <br />'es No <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 />SJ^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 />Name of organization/business: <br />... <br /> Aitemate: ( ), <br />L.st food to be sold or given to the public CM y <br />I am providing food that is NOT prepared at home H^s No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility:Phone: ( ) <br />Address of facility: __________________________________________________________ <br />|ETurn_a-£!'