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<br />/5 <br />1. <br />2. <br />3. <br />4. . I am providin' <br />5. <br />6. <br />es <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />Page? of 11EHD 16-02 <br />11/4/14 <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />foods during all times of booth operation: „ <br />I am providing the following hot temperature <br />135°F: <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />^.cn- <br />All food vendors (both for profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this event.- <br /> 1. Name of Event: f14 J H Fl f I J? M ^-fl <br />The following is information about my organization/business. <br />Name of organization/business: . <br />TqiW-jAu <br />Phone: --------------------- Alternate: ( )--------------------------------------- <br />List food to be sold or given to the public: f CJ - ---------- <br />ig food that is NOT prepared at home: 0Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0Yes No <br />Name of facility: <br />Address of Ol <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />aXit oie^W 00^ Xd are acceptable) and eonstmcted to separate food and food preparation <br />areas from the public. <br /> n~v(.p.*> 'Vrcti'im/r^nF —---------— <br />Note: The only 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 be provided in my booth by the following methods: <br />Q Approved bottled water. <br />®€n-site hose bib that is connected to a potable water source. <br /> <br /> Other (specify): - ------------ ----------------------—-----------—--------------- - <br />Electricity is provided for my booth’s use: No <br />I am providing an accurate probe thermomete^o measure the hot and cold holding of potentially hazardous <br />fnnris riurino all times of booth operation: ©Yes No <br />control for the hot holding of all potentially hazardous foods above <br />Address: <br />) 4^2-^409