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J <br />1. Name of Event: <br />2. <br />Phone: <br />) <br />3. <br />4. <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 />Name of facility: <br />Address of facility:. <br />return a signed and completed copy of this checklist to <br />Date(s): <br />EHD 16-02 <br />7/14/15 <br />the festival coordinator three(3) weeks prior to this <br />1. <br />i__Ll O ; b<S ; h <br />measure the hot and cold holding of potentially hazardous <br />canvas, plastic, similar material and fine mesh fly <br />--- ------1 a smooth and cleanable floor (concrete, <br />are acceptable) and constructed to separate food and food preparation <br />O Camp stove Q Stemo & hotel trays <br /> Double steamer ^0 Steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />U cl —— <br />N°te: ?™iOnS nOt requirlec t0 ProvWe 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 />JHApproved bottled water. <br /> On-site hose bib thatjis connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: H’Yes No <br />1 am providing an accurate probe thermometer to m™ <br />foods during all times of booth operation:^ Yes No <br />1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />AJI food vendors (both for profit and non-profit) are required to <br />p, 1WI tv mu; event. <br />Koar ■ at er non <br />J <br />The following is information about my organization/business: <br />Name of organization/business: RlQ Qg^C\(\C. <br /> <br /> Address: .Wn CA <br /> ) -^32^164 Alternate: ( <br />List food to be sold or given to the public: Br^-A-P-CpyT^- FL. <br />P c -v i>, Sp,.11vci CF\; 11; k <br />I am providing food that is NOT prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0^Yes No <br />Name of facility: cj-^LS grs, .4^ Phone: £2^) 73^'<164 <br />A 4 “Z. S- <) Pcs or> S~h~ce^- -v-gtgA. Qa <br />' TusTand £e pX? **** food and fo^-preparaton areas from flies, <br /> A booth with walls and ceiling constructed of either wood, canvas, <br />screening, completely enclosing open food areas. It will also have <br />asphalt, clean tarps and smooth wood <br />areas from the public. <br />Brother (specify):