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TEMPORARY FOOD VENDOR’S APPLICATION <br />I1.1 Name of Events, <br />2. <br />Address <br />3 <br />4. <br />5. <br />6 <br />8 <br />9. <br />meats, tamales, cooked beans, rice, <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods. <br />Approved bottled water. <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 />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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />0 On-site hose bib that is connected to a potable water source.* <br />Other (specify): A.)K <br />Electricity is provided for my booth’s use?® Yes No <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 />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 <br />^Se.«M.A(e.o's> Vi\l\ Ve&V\)O Date(s):^~t ~ is,iL*n <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. <br />Other (specify): KAa O VO <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 operationTS Yes No <br />The following is information about my organization/business: <br />Name of orqanization/businessES^ • | <br />IIo5 to. GAon "lAAQij, Qa <br />Phone: GIS-HTO_____________ Alternate: ^SS-SQ-16 <br />List food to be sold or given to the public:!^ <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:\\G2> VQ < JlL V