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TEMPORARY FOOD VENDORS APPLICATION <br /> <br />required to return a signed and completed copy of this checklist to <br />1.9/3/16-9/4/16 <br />Z <br />Address: <br />Phone:( 510' } 43-2-6165 <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Paga 7 of 11 TEMP EVENT APP <br /> Stemo & hotel trays <br /> Steam table & lids <br />uZi Other (specify) <br /> Alternate: ( 51 O’ ) 38’4-7829- <br />List food to be sold or given to the public: kettle corn, lemon shakers, sweet & grill com on the cob, water/soda <br />use: Yes Q No <br />EHD 16-02 <br />7/T4/15 <br />I am providing food that is NOT prepared at home: Yes 0 No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: __ ______________________________Phone: (1 <br />Address of facility: <br />' ^^and the pdolkO f0,,OWing: (t° prOtect my unPacka9ed food and food-preparation areas from flies, <br />w*?1.and celling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />1 areas. It wfll also have a smooth and cleanable floor (concrete, <br />acceptable) and constructed to separate food and food preparation <br />screening, completely endosinc open food <br />asphalt, clean tarps and smooth wood are <br />areas from the public. <br /> Other (specify): <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />® Approved bottled water. <br />0 On-site hose bib that is connected to a potable water source. <br />0 Other (specify): <br />All food vendors (both for profit and non-profit) are ■ <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: Soaring Over Ripon Kot Air Balloon Festival and Kite <br />The following is information about my organization/business: <br />Name of organization/business: Gotta Love Kettle Corn <br />2324 Demartini Ln <br />Electricity is provided for my booth’s <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potenfially hazsrdo'us <br />foods dunng all times of booth operation: S Yes 0 No .^-araous <br />' pr°vid‘ns the foflow‘ng hot temperature control for the hot holding of all potentially hazardous foods above <br />35 F- Not Applicable <br />0 Camp stove <br />0 Double steamer <br />0 'Electric stove top <br />Note: Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products.