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p-1831-724-57R4Marty StricklandJun Cl 15 02:36p TEMPORARY FOOD VENDOR’S APPLICATION Date(s): 2. 2-1Address: Phone: 3. 4. 5, 6. Other (specify): Yes No7. the hot and cold holding of potentially hazardous 8. iding the following hot temperature9. Note: vegetables, potato salad, egos, and dairy products. Stemo & hotel trays O Steam table & lids Other (specify) Approved bottled water. £jon-site hose bib that is connected to a potable water source. am ij>to measure Ires No control for the hot holding of all potentially hazardous foods above 0 damp stove Double steamer Electric stove top Examples of potentially hazardous food include: Electricity is provided for my booth’s use: I am providing an accurate probe thermometei foods during all times of booth operationJzT' List food to be sold or given to the public: x. I am providing food that is NOT prepared at homet^Yes □ No ~ All food is prepared on-site or is from approved commercial facilities: O Yes No Name of facility: z<C----------------_ Phone: f-------)--------J---------------------------- 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) jXAbooth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly rscreeninq 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. Other (specify):--------------------------------- ------------------------------- - ---------------------------------------------------------- Note: The only operations not required to provide enclosed booths 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: “ ) are required to return a signed and completed copy of this checklist to prior to this event, , I.Name of //? f ( The following is information about my organization/business: Name of organization/business: ———■-r-------7=7-------7------— Alternate: - meats, tamales, cooked beans, rice. All food vendors (both for profit and non-profit) the festival coordinator thfeejS) weel ' *'Jt" 1.