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received 1. Name of Event: 1, 2. Phone: 3. 4, 5. 6. Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, Page 7 of 11 V asphalt, clean tarps and smooth wood areas from the public. Sterno & hotel trays Steam table & lids [Tfbther (specify) Other (specify):—-------------------------------- Note: The only operations not required to provide enclosed booths I am 135°F: All food vendors (both for profit and non-profit) are Received Time Jun. 21. 2016 2:55PM No. 0908 7/14/15 Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. i are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: measure the hot and cold holding of potentially hazardous JUN 21 2016 TEMPORARY FOOD VENDOR’S APPLICAWo«NTai health required to return a signed and completer/copy’oftliis checklist to the festival coordinator three (3) weeks prior to this event. TEMP EVENT APP 3 The following is information about my organization/business: Name of organization/business: Approved bottled water. On-site hose bib that is connected to a potable water source. Electricity is provided for my booth’s use: EfYes No I am providing an accurate probe thermometer to measi foods during all times of booth operation: 0 Yes No providing the following hot temperature control for the hot holding of all potentially hazardous foods above Address. Alternate^ )_— ------------ List food to be sold or given to the public: £ I am providing food that is NOT prepared at home: EEfYes No All food is prepared on-site or is from approved commercial facilities: B'Yes No Name of facility:--------------------------------------~ PhOne’ - ------------------- Address of facility:._________ _______________ _——---- -------------— ------------—---------—- I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) 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 asohalt clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation