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TEMPORARY FOOD VENDOR’S APPLICATION <br />the festival coordinator three <br />1.1. Name of EventT <br />2. <br />3. <br />4. <br />Io <br />•2/6- <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br /> \ <br />EHD 16-02 <br />7/14/15 <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing an accurate probe thermoi; <br />foods during all times of booth operatjprff <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Vj Approved bottled water. <br />It will also have a smooth and cleanable floor (concrete, <br />fe)) and constructed to separate food and food preparation <br /> 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. " <br />asphalt, clean tarps and smooth wood are acceptal <br />areas from the public^ i / <br />JAJOther(specify^Z^C^/^/^ { <br />/ Note: <br />i-site hose bib thatjs connected to ^potable water source. <br />•ther(specifv):^^:^^?/^-^ <br />Electricity is provided for my booth’s use: Yes^^No <br />5r to measure the hot and cold holding of potentially hazardous <br />Yes No <br />' Vid*n9 the following hot temPerature control for the hot holding of all potentially hazardous foods above <br />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 /> z . _ Alternate^ ) _____ <br /> List food to be sold or given to the isfP <br />I am providing food that is NOT prepared at home/^Yes No <br />All food is prepared onsite or is from approved commercial facilities:^-Yes <br />Name of facility^ Phone <br />Address of facility? <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 /> Camp stove <br />Kj Double steamer <br /> Electric stove top <br />Date(s): <br />’0£Ve.nd0rS..(b0th for ^Xksprior to thif Xe^ t0 retLJm 3 S,9ned 3nd COmpleted Copy of this checkJist to <br />The following is information about my or^ptzSTion/business: <br />Name of organization/business:' ' <br />Address:^^ <br />Phone^-^//7-^’) <br />List food to be sold or given to the pub