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2. <br />3. <br />4. <br />5. <br />6. <br />8.I am providing an accurate measure the hot and cold holding of potentially hazardous <br />9. <br />iaily meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />5 <br />□fApproyed bottled water. I i <br />Q"On-site hose bib that <br /> Other (specify); <br />screening, completely <br />asphalt, clean tarps and <br />areas from the public. <br /> Other (specify);____ <br />Note: The only operations <br />approved dispensers <br />I non <br />i) vjteeks prior to this <br />I am providing food that is NOT pn V <br />All food is prepared on-f ite is from <br />Name of facility: // <br />Address of facility: <br />Approved water for drink ng, (.(tensi <br />I <br />I <br />H <br />aPen areas- I1 a*9° have a smooth and cleanable floor (concrete, <br />smooth w ood are acceptable) and constructed to separate food and food preparation <br />i ' <br />j <br />| <br />not required to provide enclosed booths are those which sell beverages from <br />£HD 16-02 <br />7/14/15 <br />Date(s): <br />Alternate:^ <br />List food to be sold or given to the public: <br />i ------- ----------------------------------------- <br />providing food that is NOT prepared at home: No <br />.J approved commercial facilities: <br />' ' <br />I am providing a booth vyrth ■ J e foil iwing: (to protect my unpackaged food and food-preparation areas from flies, <br />oust and the public) <br />Eta booth with walls and ce ling instructed of either wood, canvas, plastic, similar material and fine mesh fly <br />p Stenjo & hotel trays <br />STSteam table & lids <br />Li Other (specify) <br />hazardous food include: <br />ad, eggs, and dairy products. <br />II 1 <br />I <br />Pag* 7 of 11 <br />I <br />II___---i <br />B <br />TLAll food vendors (both for profit arid <br />the festival coordinator three (3) wee <br />1. 1. Name of Event: <br />1 Fm Irxz^ L <br />, .Mvrw...vvl^ <va K I IIC3UVI l| (ll/V/ ___ <br />Name of organlzation/buslness: __ <br />Address: ~73 CT<Bd /zw <br />Phone: - <br />IIconnect^ to a potable water source. <br />I_J vu.oi vopcvt.y;. -----------------. ;,■ ■■■, 1------------------------ ._______________ <br />7. Electricity is provided for my iaoth'ji use: E^YeTo No <br />hermometi <br />[jJCapip stove <br />LrTbouble steamer <br /> Electric stove top <br />Note; Examples of pptei <br />vegetables, potato s <br />s <br />i <br />3 obe_______ _______ <br />foods during all times c|f bqijjth operation: EjYes No <br />1 T Pr°vi5P0 tf16 following hM temperature control for the hot holding of all potentially hazardous foods above <br />135 <br />I] <br />|! <br />I; <br />J'Yes LJ No <br />Phone: f 3 73-^5X> <br />li <br />ORARY FOOD VENDOR'S APPLICATION <br />jprofit) are required to return a signed and completed copy of this checklist to <br />x " '»event.i <br />The following is informaflon| about my organization/buslness: <br />Name of organizational jslnjss: <br />|or pre packaged foods from approved sources. <br />and hand washing will be provided in my booth by the following methods: