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TEMPORARY FOOD VENDOR’S APPLICATION <br />1.1. Name of Event: Date(s): ZV ZO!) <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br /> Other (specify): <br />those which sell beverages from <br />6. <br />7.Electricity is provided for my booth’s use: 0 Yes No <br />8.the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />EHD 16-02 Paafl 7 nt 11 TFMP PVPNT ADD <br />[3 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />® Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br /> Steam table & lids <br />S Other (specify) JytoU'* <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Note: The only operations not required to provide enclosed booths are <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 />S Approved bottled water. <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: 0 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 NOT prepared at home: £3 Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility:_______________Phone- ( ) <br />Address of facility: <br />* ^s^and the pub)0? thG follOWin9: (t° prOtect my unPackaged food and food-preparation areas from flies, <br />S 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. <br />thL proX\and 2on’profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks poor to this event. <br />The following is information about my organization/business: <br />Name of organization/business. St. q# k M priori Cj}nrch <br />('Z-OT ). ~ 6? (p |Alternate: ( ) HR"! • Vcl <br />(9ue.sac(i|lns_____________ _