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/ J Date(s)/ <br />1. <br />2. <br />Alternate: ( <br />3. <br />s' At <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />TEMP EVENT APPPage 7 of 11 <br />\ <br />EHD 16-02 <br />08/01/16 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of <br />S'sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />potentially hazardous food include: <br />All food vendors (both for profit and non-profit) <br />the t—--------- - <br />)________ <br />/m /i 'Kt <br />7^-2 / <br />------------------------------------------------ ' '■ <br />si^^\ > 45 <br />_____• <br />32/ <br />during all times of booth operation:'^ Y< <br />I am providing the following hot temperature <br />135°F: <br />[3T>ther (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, utensil and band 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 />-1 O / <br /> Other (specify): ~ <br />Electricity is provided for my booth’s use:Yes No <br />, am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation, jxj Yes LI No <br />control for the hot holding of all potentially hazardous foods above <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />-) are required to return a signed and completed copy of this checklist to <br />SJa^ordSr thre^S) weeks prior to this event. <br /> S.ZL .. <br />The following is information about my organization/business: <br />Name of organization/business.------L—<2. <br />Address: xS CJ <br />Phone: ( 2 c/7) <br />List food to be sold or given to the public. <br />I am providing food that is NOI prepared at home: Yes No <br />All food is prepared on-site or is from approved commercial facilities. K Yes No <br />______ _ Phone: (____1Name of facility: ------- ---------- --------------------------------- <br /> Address of facility:---------------------------------------------------------------------------------------------- <br />! am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />booth With walls and ceiling constructed of either wood ?nvas. plastic similar XTirno^Srete <br />Xd "pible) and constructed io separate food and feed preparation <br />areas from the public.