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TEMPORARY FOOD VENDOR’S APPLICATION Date(s): 1. Name of Event:1. 2. Address: Phone: 3. 4. 5. 6. 7. the hot and cold holding of potentially hazardous8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 of 11EHD 16-02 11/4/14 All food vendors (both for profit and non-profit) are 5 Approved bottled water. 3 On-site hose bib that is connected to a potable water source. s 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: Camp stove Double steamer Electric stove top Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Other (specify):_ _ _ Electricity is provided for my booth’s use: Yes No I am providing an accurate probe thermometer to measure foods during all times of booth operation: Q Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Other (specify):_____ __________________ Note: The only operations not required to provide enclosed booths C^Sterno & hotel trays Steam table & lids Other (specify) Qrj|| I am providing food that is NOT prepared at home: Q Yes No All food is prepared on-site or is from approved commercial facilities: Q 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) n 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. required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Islptnn Cajun A Rlnes Festival The following is information about my organization/business: Name of organization/business: Cajun Queen----------- _______nob 1693 Middletown CA 95461 ( 7n7 ) ggy 91 A? Alternate: (510 ) 410 9146-------------------------- List food to be sold or given to the public: Alligator, Crawfish, Shrimp, Cmib^Cakes^Fr^s, Beigne^/^M^