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TEMPORARY FOOD VENDOR’S APPLICATION <br />Thursdays May-Oct1. Name of Event:1.Date(s): <br />2.The following is information about my organization/business: <br />M J' C-r L( CName of organization/business: <br />Address: <br />(iS4Phone: <br />3. <br />4. <br />5. <br />T7E^Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />0 Other (specify): <br />Electricity is provided for my booth's use: Q Yes 0 No7. <br />8. <br />9. <br />T-.MP ( VENVAFPPage 7 of 11EHD 16-02 <br />08/01/16 <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: 0 Yes No <br /> Sterno & hotel trays <br />0 Steam table & lids <br />Q Other (specify) <br /> Camp stove <br />0 Double steamer <br />0 Electric stove top <br />J /'ocrl <br />0 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 />0 On-site hose bib that is connected to a potable water source. <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 />Market On Maple <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />-f / Vcjie. <br /><a) Ka- ^Tyi txyx <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 />iai <br />meats, tamales, cooked bc.n. 'ice, <br />T k r y <br />f f <br />Alternate: (% I o ) £? | Q - 43 <br />h klrx c !o li vt*List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home: 0 Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: C K i Phone: <br />Address of facility: ^ | [ / Ia/a y It) (J 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)