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Date(s). <br />1. <br />2. <br />Li-J) 1 <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <br />Page 7 of 11EHD 16-02 <br />08/01/16 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />All food vendors (both for pr°^ an<^ non-profit) <br />)_-------------- <br />S > h <br />S'cterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />/ S ________________ <br />required to provide enclosed booths <br />■t L> C / <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />~) are required to return a signed and completed copy of this checklist to <br />S'^tor^S) ^ prior to this event. ~ <br />1. Name of Event: Aw r^L Date(s). I ' <br />The following is information about my organization/business: <br />Name of organization/business:------. <br />Address: C C----------—--------- <br />Phone: ( ^-?) _32j_JZ£ZZ_-----y-—- ^ate: < <br />List food to be sold or given to the public: <br />I am providing food that is NOI prepared at home: ^-YesO No <br />Al food is prepared on-site or is from approved commercial facilities: ® Yes No <br />_____Phone: (_____L\ <br />Name of facility: -------------------------------------------- ------------------------- - <br />Address of facility:------------------------------------------------------------------------------------------------ <br />, am providing a booth with the foiiowingr (to protect my dnpaokaged food and food-preparatron areas fmm dies, <br />dust and the public) <br />BTa booth with wails and eeiiing eonstraeted either wood, rranvas. X^rSXete’ <br />-od ar°e a^eptabie) and constructed to separate food and food preparation <br />areas from the public. <br />''Bother (specify):. <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, utensli 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 /> Other (specify):--------------------------------------------------------------------------------------------------- <br />Electricity is provided for my booth’s use:"0. Yes No <br />, ,m providing an accurate probe thermometer to measure th. hot and coid holding of potentially hazardous <br />foods during all times of booth operation, Yes LJ No <br />I am providing the fo.lowing hot temperature centre! for th. hot holding of an potentiaNy hazardous foods above <br />135°F: