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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event:1.Q <br />2. <br />Name of organization/business: <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br />6. <br /> Approved bottled water. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />08/01/16 <br /> Other (specify):____ _____________________ <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Sterno & hotel trays <br /><tS.Steam table & lids <br />Other (specify) <br />T&lk AlAC- <br /> Camp stove <br /> Double steamer <br />Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />On-site hose bib that is connected to a potable water source. <br /> Other (specify):___________________ ____________________ <br />Electricity is provided for my booth's useYes 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: Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <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. & r / <br />qV A v jTo? ______________-__Date(s):y (3/% <br />The following is information about my organization/business: <br />( C________ _ <br />Address:C ^^38^ <br />T^S) ^9^ ______________ Alternate: )_( ^7--------- <br />C A 0 _ <br />bcdjUM ) <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:Yes No <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 />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.