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TEMPORARY FOOD VENDOR’S APPLICATION <br />I1 <br />2. <br />3. <br />4. <br />5. <br />Fl Other (specify): <br />6. <br />•ved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />d Other (specify): <br />7. <br />8 <br />9. <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 />Fl Camp stove <br /> Double steamer <br />Q Electric stove top <br />Electricity is provided for my booth’s use?® Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 Event^^T« <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 /> Sterno & hotel trays <br /> Steam table & lids . <br />TJj Other (specify) CP <br />meats, tamales, cooked beans, rice, <br />The following is information about my organization/business: <br />Name of orqanization/businessSV» \J | <br />Address: I(o5 Iaj. TEACij, Ca qsaiu <br />Phone: () 0IS~inO Alternate: 4) <br /> <br />List food to be sold or given to the public:?^ O -CoXheS, C-Q^\oa> (ja Llchj Pci^Poinfe <br />I am providing food that is NOT prepared at home^Q Yes No <br />All food is prepared on-site or is from approved commercial facilities^] Yes No <br />Name of facility: ^(2£> S Phone: ( ) <br />Address of facility: \ r CkVckM <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.