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5TEMPOR ?Y FOOD VENDOR’S APPl ;ation <br />1. <br />2 <br />Address: <br />3 <br />4. <br />5. <br />6. <br />jl/'dther (specify) <br />7 <br />8 <br />7 <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 />Q^Sterno & hotel trays <br />E'ISteam table & lids <br />0 Other /specify) <br />Approved water for drinking, utensil and hand washing will be provided in my pooth by the following methods. <br />^Approved bottled water. <br />lJ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar matenai and fine mesh fly <br />screening, completely enclosing open food areas. St will also have a smooth and cleanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. • <br />ftTother (speat/):^ "[Al- ____ <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 />Note; Examples of potentially hazardous food include- <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135CF: <br />jV'Camp stove <br />0 Double steamer <br />Fj Electnc stove top <br />i ! On-site hose bib that is connected to a potable water source. <br />Electricity is provided for my booth's use 0 Yes No / <br />I am crowding an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during ail times of booth operation: [JfYes O No <br />meat*?, conked beans, rice, <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Name of Event^>17 Datefskk^ <br />The following is information about my oraanizabon.^isiness <br />Name of organization/business: <br />IZBT- CfeK JZ <br />Phone: Alternate: ( an, 4^3 -1^54 <br />v»Z, z <br />List food to be sold or given to the public kC/A-FLA , Q IZO ^CAs | <br />I am providing food that is NOT prepared at home. Yes f 1 No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility:Phone: ( ) <br />Address of facility: