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I <br />temporary <br />1. <br />2. <br />Address: <br />Phene: <br />2 <br />4. <br />5. <br />6. <br />7 <br />3. <br />9. <br />meats, tamales, cooked beans, rice, <br />temp event ap? <br />Page 7 cf 11 <br />EHu 15-02 <br />1V4/14 <br />FOOD VENDOR’S APPLiCAT!ON <br />a signed and completed copy <br />ed commercial facrities. L3 Yes .. . I''hd <br />packaged food and food-preparation areas from flies <br /> Other (specify):------------------------------------------------------------------ “ <br />- K!1 ™ <br />Appwed water tor drhktn,. trtana. and hand P-dad in my booth by the fottowng mathods. <br />2 Approved bottled water. <br />5?i On-site hose bib that is connected to a potable water source. <br /> Atematarr^’ifSC^ZZ? . <br />asternoS hotel trays <br /> Double steamer Stesm tsbls & lids <br /> Electric stove top Dther (sPeciY <br />Note- Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />y Other (specify): ____---------------------——— -----— <br />Electricity is provided for my booth’s use: H Yes No <br />, am an ac=urate pmba ~ ““ “ <br />foods during all times of booth operation. J31 =s - <br />, am Pedina th. «ng hot tampan contmt hz the hot hotding at a. potanMy hazardous tdoda aeova <br />135T: <br />Ail food vendors (both for profit and non-profit) are required to return <br />JtL -estival coordinator three (3) weeks poor to this ev=m <br />Name0, Event. fiWohfT Hg— <br />M^ng ts ~ <br /> Name cf organization/business: -----L--— <br /> <br /> <br />List food -.o be sold or given to the public. <br />I 2m providing food that is NOT prepared at homeM^s <br />All food is prepared onsite or is irom appm j ~ - <br /> <br />Name of facility: <br />Address of facility:. <br />I am providing a booth with the following: (to protect my um <br />dust and the public) <br />^A boom with walls and casing aomwgdaNKIwr wood canvas. PMumw JJ.naale ,to0. (conffate. <br />£7an“nd"S S S1^) and e—d to separate food and food prapa^n <br />areas from the public. <br />of this checklist to <br />a_ dc^2^^,