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TEMPUKARY FOOD VENDOR’S APPLICATION <br />1.I.Name of Event: Date(s): <br />2. <br />Name of organization/business:> <br />C- vAddress:1 S' sro <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br />3 <br /> On-site hose bib that is connected to a potable water source. <br />^Other (specify): <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />( ZSc *7 ) ^7^- Sts ( <br />EHD 16-02 <br />List food to be sold or given to the public: J-| > etA <br />pro/fitxand non“Prof't) are required to return a signed and completed copy of this checklist to <br />ine festival coordinator three (3) weeks prior to this event. <br />1 a^Providing the following hot temperature control for the hot holding of all potentially hazardous foods above <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 />1 ^s^d th9 3 With thS fOllOWin9: (t0 protect my ^Packaged food and food-preparation areas from flies, <br />5(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 />___ Alternate: ( ) _____________________ <br />Go <br />I am providing food that is NOT prepared at home: Yes jj^xlo <br />All food is prepared on-site or is from approved commercial facilities: [^Yes No <br />Name of facility: Phone: (34-7) S'~&ciST <br />Address of facility: i <br />C tv 'ATr' q . ______________________________________ <br />Electricity is provided for my booth’s use: Yes I^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: (SlYes No <br />The following is information about my organization/business: <br />s' < - -VG G