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I* <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1.Date(s): <br />2. <br />12 <br />Phone: <br />3. <br />4. <br />5. <br />those which sell beverages from <br />6. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 erf 11 TEMP EVENT APP <br /> Camp stove <br /> Double steamer <br />Q Electric stove top <br />EHD 16-02 <br />11/4/14 <br />are required to return a signed and completed copy of this checklist to <br /> Stemo & hotel trays <br />pJ^Steam table & lids <br />Other (specify) 'A'Va l—tc^ <br />Note: Examples of potentially hazardous food include: <br />• vegetables, potato salad, eggs, and dairy products. <br />Note: The only operations not required to provide enclosed booths are <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 />^Approved bottled water. <br />Q On-site hose bib that is connected to a potable water source. <br /> Other (specify): _______________ ___________________ <br />7. Electricity is provided for my booth’s use^Xf Yes No <br />8. 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: Yes No <br />1 Pr°vidin9 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135 F: <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: CgjW <br />The following is information about my organization/business: <br />Name of organization/business: 5 -1|AC <br />Address: ^50 \ Hvoy Wi CA <br /> Alternate: ( <br />List food to be sold or given to the public: p vxA. <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: S.Yes No <br />Name of facility: Phone <br />Address of facility: \T <£(V\ Ut A <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 />KA 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 />ar^sfronTttie131^ Sm°Oth WOO<:1 are accePtable) and constructed to separate food and food preparation <br /> Other (specify):