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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s):I.Name of Event: 1. <br />2. <br />Phone: <br />3. <br />4: <br />5. <br /> Other (specify); <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APRPogo 7 uf 11 <br />i ii mu <br />(3>Camp stove <br /> Double steamer <br /> Electric stove top <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 />t&Stemo & hotel trays <br />l?4 Steam table & lids <br /> Other (specify) <br />Name of organizatiorVbusiness: _ <br />W 1. <br />nc,______ <br /> Approved bottled water. <br /> On-site hose bib that is connected to a potable water source, <br />Mother (specify): fa. <br />Electricity is providod for my booth's use: IZlYes Q No <br />EHD 1 fl-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 the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135VF: <br />I am providing an accurate probe thermomotor to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ®-Yes No <br />i_j/s ii n /s <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 />..........................Date(s): /zy/Zpfi, <br />The following is information about my organization/business: <br /><J?ne Mak, I1 <br />Address: _ <br />(Srf) ^3 7 __ Alternate: ( ) <br />List food to be sold or given to the public:. 1 <br />I am providing food that is NOT prepared at home:J^Yes No . <br />All food is prepared onrsjte or is from approved commercial facilities: $}Yes No <br />Name of facility: fklAOC- Phone: <br />Address of facility: - C/t <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 />EiA 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.