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TEMPORARY FOOD VENDOR’S APPLICATION 1 2. Address: 3. 4. 1 5. Other (specify): 6 On-site hose bib that is connected to a potable water source 7. 8. 9. meats, tamales, cooked beans, rice, Page 7 of 11 TEMP EVENT APPEHD 16-02 7/14/15 Camp stove Double steamer Electric stove top Other (specify):_________ Electricity is provided for my booth s use: D Yes FT No I am providing an accurate probe thermomet; foods during all times of booth operation: m Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources I am providing food that is NOT prepared at home: Q Yes I I No All food is prepared on-site or is from approved commercial facilities: Name of facility: __________________________________ Address of facility:_ V to measure the hot and cold holding of potentially hazardous Yes No AllTOC’D FRfcfRiTL-P’ C’K) iTt: Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135T: Soes No _ Phone' (___ Date(s): u? 5 V Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 0 Approved bottled water I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dqst and the public) Lj 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 The following is information about my organization/business. Name of organization/business: t^OOD) PUpp^/'S O" C.>flTTVSH __ Phone; ( AIS) 1/ J Cl ID Alternate' ( ) List food to be sold or given to the public: W-iQ? CATTiSi4 " J/TtyIi^TCVA - fOltT Si-fYlAj Sterno & hotel trays Steam table & lids j S Other (specify) pitC'i' A'K t iduiuVci cS I LC'Lv OI~U 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. 1 Name of Event: C ftjUAJ r i^CU.F'S TLSHV