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5 <br />TEMPORARY FOOD VENDOR’S APPLICAI iON <br />1.1. Name of Event:Date(s): <br />2. <br />Address: <br />Phone: <br />3 List food to be sold or given to the public:+ <br />4. <br />5. <br /> Other (specify): <br />6. <br />.^TOther (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <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 />135°F: <br />I am providing an accurate probe thermometep <br />foods during all times of booth operation: 0ti <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 />EHD 15-02 <br />11/4/14 <br />[^TSterno & hotel trays <br />Y^Tteam table & lids <br />IZ'other (specify) <br />0<3amp stove <br />EzDouble steamer <br />O Electric stove top <br />Electricity is provided for my booth's use: ©'Yes No <br />Pq<) <br /> On-site hose bib that is connected to a potable water source. <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 />[l/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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />^Approved bottled water. <br />measure the hot and cold holding of potentially hazardous <br />'es No <br />ex I -T^_____ <br />Ci yiio <br />3res No <br />Phone: £ <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 threelS) weeks prior to thi^Yvent. <br />(Ljh) (9 vvJc <br />The following is information about my organization/business: <br />Name of organization/business: J J n g S' r_7 <br />XJIOjL- __ <br />( CfO ) S'V<~ Alternate: ( ) <br />"ft?/TVy* nd ljI <br />I am providing food that is NOT prepared at home: H*Yes No <br />All food is prepared 4n-site or is from approved commercial facilities: f <br />Name of facility: <br />Address of facility: cj i_, tyR ovh-