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■ <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):1. <br />3. <br />4. <br />) <br />C VVOSmother (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />TEMP EVEN‘D APRPage 7 of 11 <br />All <br />th( <br />) 16-02 <br />11/16 <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 />Note: The only operations not required to provide enclosed booths are those which sell beverages fror i <br />approved dispensers, or prepackaged foods from approved sources. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />2. <br />meats, tamales, cooked beans, rice, <br /> On-site hose bib that is connected to a potable water source. <br />Pifi-______________ <br />5. <br />Address: <br />Phone: <br />0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fl <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 preparatio i <br />areas from the public. <br />P lh <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />■ <br />Other (specify): <br />Electricity is provided for my booth’s use: Yes No <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: Yes [5{No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods abo e <br />135T: <br />iod vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist tc <br />sstival coordinator three (3) weeks prior to this event. Thlll'days <br />1. Name of Event: Market on Maple Datefs): May-Oct. - f- <br />The following is information about my organization/business: <br />Name of organization/business:, j <br />< SLt><|) T I 'v - S H 6 &_________ Alternate: ( Slt> )3«>l - 05 f <br />List food to be sold or given to the public: | A-cjlSj ___________I <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: Yes (3*No <br />Name of facility: p Ift Phone: ( <br />Address of facility:_____________________ ___