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TEMPORARY FOOD VENDOR’S APPLICATION F&S>Yi\rnl1.1. Name of Event: 2. Address: (2P9)Phone: 3.List food to be sold or given to the public: 4. 5. 6. 7.Electricity is provided for my booth’s use: E Yes No 8.the hot and cold holding of potentially hazardous 9. meats, tamales, cooked beans, rice, EHD 16-02 Paap7 of 11 TFMP «=>/PMT A DO KI Camp stove Double steamer Electric stove top ^3 On-site hose bib that is connected to a potable water source. Other (specify):_____________________________ Sterno & hotel trays Steam table & lids S Other (specify) Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. Name of organization/business: 3.03 b- I am providing an accurate probe thermometer to measure foods during all times of booth operation: 0 Yes No I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Alternate: ( f 7 ~ H V /red I am providing food that is NOT prepared at home: 0 Yes No All food is prepared on-site or is from approved commercial facilities: M Yes No Name of facility: Phone- ( ) Address of facility: Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 0 Approved bottled water. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies dust and the public) 0 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, asphalt, c*e^n *arPs anc^ smooth wood are acceptable) and constructed to separate food and food preparation Other (specify):___________________________ All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to the festival coordinator three (3) weeks prior to this event. The following is information about my organization/business: Sr /Ufln/s_of' 'Hie, W- DbH Fi I ip i n o Date(s): /FlJ F 2D LOP