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All food vendors (both for profit and non-profit) <br />J Date(s):'2 <br />1. <br />2. <br />c <br />3. <br />4. <br />5. <br />screening, completely enclosing open food <br /> Other (specify): <br />6. <br />7. <br />the hot and cold holding of potentially hazardous <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />temp event appPage 7 of 11 <br />6 <br />EHD 16-02 <br />08/01/16 <br />S'Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Name of organization/business: <br />)_____ -------------------- <br />1 i r* act’s'll <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />of potentially hazardous food include: <br /><; 6 <br />'321- 2 7 Alternate: ( <br />7 s <br />Note: Examples c. r , <br />vegetables, potato salad, eggs, and dairy products. <br />i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />"') are required to return a signed and completed copy of this checklist to <br />/“Ml IWU »viimviw ------r . <br />the festival coordinator three (3) weeks prior to this event. <br />^^5/ Date® <br />The following is information about my organization/business. <br />54- <br /> Other (specify): <br />Electricity is provided for my booth’s use: ®Yes No <br />I am providing an accurate probe thermometer to measure <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 />I am providing food that is NOJ prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities: S’Yes No <br />£, .... Phone: (IName of facility: -------------- ------------------------------ -------------------------- <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 />B-A booth »th walls and celling constructed either wood, .canvas. similar material <br />5^0^ wS ar°e acceptable) and constructed to separate food and food preparation <br />areas from the public. <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 />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />Address: <br />Phone: ( •^cV/) <br />List food to be sold or given to the public: —1----- ------