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signed and completed copy of this checklist to <br />1. <br />2. <br />Phone <br />3.S,c7-H-'A,x y <br />4, <br />5. <br />4,■ I.,- <br />g <br />7 <br />8.I am providing an accurate probe thermomei <br />9. <br />cooked beans, rice, <br />Page ~ of 11 TEMP EVENT AP<? <br />3 <br />I am <br />All food is prepared on-sjte <br />Name of facility <br />Address of facility. <br />EHD 16-02 <br />7/14/15 <br />List food to be sold <br />in my booth by the following methods <br />or given to the public <br />i v^AjatefsttcJurc 2-5124c <br />^3-On-site hose bib that is connected to a potable water source <br /> Other (specify) <br />res Q NoElectricity is provided for my booth s use: <br />meats, tamales, <br /> Sterno & hotel trays <br />P l Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy oroducts. <br />fnnd/d. r n ii r r ! P thermomo£Uc measure the hot and cold holding of potentially hazardous <br />roods during all times of booth operation: J/TYes ■! I No <br />1 a^provfciing the following hot temperature control for the hot holding of ail potentially hazardous foods above <br />□ Camp stove /^'^~ <br />O Double steamer <br /> Electric stove top <br />Note: The only operatons not required to provide enclosed tooths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources <br />Approved water for drinking, utensil and hand washing will be provided <br /> Approved bottled water. <br />T EMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non profit) are required to return a <br />the festival coordinator three (3) weeks prior to this event <br />1 Name of Event: P)l I i <br />The following is information about my organization/business <br />Name of organization/business -Ttotskd Kl Shr War in <br />Add^s Cuuko fL'nlway. OiSCov^ K? y C/ <br />Alternate ~7^~/0°} <br />T\-t (r-^fn <br />providing food that is NOT prepared at home.;>QYes No <br />or is from approved commercial facilities HYes No <br />W ______'Phone. <br />—it. i^v <br />1 dusSthepuW?)1 ;hS fOllOW,;19 (t° proteCt my food and food-preparation areas from flies. <br /> A booth with walls and ceilmg constructed of either wood, canvas, plastic, similar material and fine mesh flv <br />screening completely enclosing 0Den food areas It wHI also have a smooth and deanabteJ floor (concrete <br />aXs fromThe tobV'^ aCCeptaWe) and co"str“cted to separate food and food preparation <br />J3<Dther (specify)