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img081.jpg Page 1 of 1 TEMPORARY FOOD VENDOR’S APPUCATION i.1. Name of Event: 2. Address: 3. 4. 5. QtJther (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 APP https://mail.google.eom/_/scs/mail-static/_/j s/k=gmail.main.en.4L9bVmWxiEc.O/m=m_i,t...6/14/2016 EHD 16-02 7/14/15 Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: Q'Xpproved bottled water. O 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 cteanable floor (concrete, asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Other (specify): Electricity is provided for my booth’s use: Yes B"No I am providing an accurate probe thermometer foods during all times of booth operation: Camp stove Double steamer Electric stove top ^to measure the hot and cold holding of potentially hazardous 'es No Sterno & hotel trays Steam table & lids Other (specify) 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 135°F: Date(s): 20 Name of organization/business: t , I iCCrYO Phone: F) I Alternate: (A |C> ) 2 A Q ~ 8 List food to be sold or given to the public: *5 ; ,4 c J. I am providing food that is NOT prepared at home: EJVes No All food is prepared Ofcsite or is from approved commercial facilities: EET/es No Name of facility: I bOGn | Q, C'C'J A^^hone: (A(C)S^-^ Address of facility: -1-I-r~l ^_T) I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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. The following is information about my organization/business: