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TEMPORARY FOOD VENDOR’S APPUCATION <br />required to return a signed and completed copy of this checklist to <br />1.Date(s): <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />It will also have a smooth and cleanable floor (concrete, <br />6. <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9.above135°F: <br />i <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />J <br />! <br /> ^?'4~ 3 <9 ~7 <br /> Alternate: ( <br />I am providing food that is NOT prepared at home:^fVes No <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: <br />Address of facility: <br />EHD 16-02 <br />7/14/15 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Note; Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />are those which sell beverages from <br />J <br />1 ^Ts^andthe pub °c? W'th f°ll0Win9: (t° prOtect my unPacka9ed food and food-preparation areas from flies, <br />3^ 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 />areaTfronTthe pubT Sm0°th W0°d are accePtable) and constructed to separate food and food preparation <br /> Other (specify):_________ ______ <br />Note: The only operations not required to provide enclosed booths <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 /> On-site hose bib that is connected to a potable water source. <br />Gather (specify): <br />Electricity is provided for my booth’s use: Yes^Alo <br />1 am providing an accurate probe thermometertp measure <br />foods during all times of booth operation: F^Yds No <br />1 a™ PerovicJfn9 the following hot temperature control for the hot holding of all potentially hazardous foods <br />All food vendors (both for profit and non-profit) are ‘ <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: (Q(J <br />The following is information about my organization/business: <br />Name of organization/business: ~TCc- <br />_. J J c <br />List food to be sold or given to the public; <br />SZP/es No <br /> Phone: {1