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TEMPORARY FOOD VENDOR’S APPLICATION Date(s):1.1. Name of Event: 2 Address: Phone: 3.List food to be sold or given to the public: 4. 5. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. Approved bottled water. U Sh IEZ Other (specify): 7. 8. 9. meats, tamales, cooked beans, rice, TEMP EVENT APPPage 7 of 11 \ EHD 16-02 08/01/16 I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 0 Yes No Sterno & hotel trays Steam table & lids Other (specify) "pt jy) i Phone: (2^7) ~1 IC3- Z. o /tH _ • T~. C c,. S V3 / on-site or is from . UpuW-z A .-(cy On-site hose bib that is connected to a potable water source. U Ci /if U Sin i 4^ cyi Electricity is provided for my booth’s use: Yes 0 No Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. Thursdays Market on Maple May-Oct I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Camp stove Double steamer Electric stove top The following is information about my organization/business: Name of organization/business: cd, Av-c Cc<- Q&'i ) ~7<-fO-(4>'Z 3l Alternate: ( ) H \-ft- pA /I DC>5 C C‘ rDolen S I am providing food that is NOT prepared at home: 0 Yes □ 1 V) All food is prepared on-site or is from ^pproved^commercial facilities: 0 Yes No Name of facility: Address of facility: bQ < j-L I Ct/icl Ar/C.j . I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, 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): ?)CC>IVa LOfrll.S , No Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources.