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MAY/29/2015/FRI 11:32 AM P. 004FAX No. 9164800282RCWYNSPRII <br />C..W <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />.1. <br />2. <br />Address: <br />3. <br />4. <br />5, <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 erf 11EHD <br />11/4/14 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: The oniy operations not required to provide enclosed booths 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 tie provided in my booth by the following methods; <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />IS A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely-enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />6. <br />• ^X?Approved bottled water. <br />Jkf6n-site hose bib that is connected to a potable water source. <br />. Date(s): 20-77-zozr <br />I am providing a booth with the, following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event: <br />The following Is information about my organization/business: <br />Name of orqanization/business: ~dN\ f) d/O S ~ <br />_7^ [__( __________ <br />Phone: (I . Alternate: ( ) <br />List food to be sold or given to the public:^lA — f i(2_-kiea\ <br />I am providing food that is NOT prepared at home; [/j^es No <br />All food is prepare^on-sitejjr is from approved commercial fadltties:y0^es No <br />Name of facility:Phone: ( ) <br />Address of facility:_ <br /> Other (specify):' ■ _1 • <br />Electricity is provided for my booth’s use: ^fes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation^^es No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135*F: