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Fk/5 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />11. <br />2. <br />3. <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6 <br />7 <br />8 <br />9, <br />meats, tamales, cooked beans, rice, <br /><o <br /> On-site hose bib that is connected to a potable water source. <br />Fl Other (specify): __________________________________ <br />Electricity is provided for my booth’s use>Q Yes Q No <br />I am providing an accurate probe thermoj <br />foods during all times of booth operation: <br />Phone: <br />List food to be sold or given to the public: KjOtVA 0.K <br /> Stemo & hotel trays <br />Steam table & lids <br />—S Other (specify) Jp <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: The only operations not required to provide enclosed booths are <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 />Approved bottled water. <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 />1. Name of Eventfift ■ VesA'i X) a Date(s):^ " ts.i^n <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flips, <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. <br />leter to measure the hot and cold holding of potentially hazardous <br />3 Yes No <br />The following is information about my organization/business: <br />Name of orqanization/businessSV • | <br />Address: I Io5 tO . ftyVd'Q-'i l SST] (<? <br />(JCff) US-lFie, Alternate: (^^ <br />I am providing food that is NOT prepared at homeST] Yes No <br />All food is prepared on-sitemr is from approved commercial facilities>'0 Yes No <br />Name of facility: K> Phone: (}________________________ <br />Address of facility: k) tA O ___________