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TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7.Electricity is provided for my booth’s use: S Yes No <br />8.the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />EHD 16-02 Panp 7 nf 11 PVFNT ADO <br />B Stemo & hotel trays <br /> Steam table & lids <br />t I Other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Camp stove <br /> Double steamer <br /> Electric stove top <br />0 On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Date(s): fluff ZZ)|7 <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: O Yes No <br />All food is prepared on-site or is from approved commercial facilities: ® Yes No <br />Name of facility:phone; L <br />Address of facility: <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 />£3 Approved bottled water. <br />I am providing a with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />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 /> Other (specify): ________ _________________________ <br />£et0 retUm 3 Si9ned and C°mpleted °f thiS che" <br />1. 1. Name of Event: .^7 Mari/fl hmiL/ Pcs h \/g I <br />The following is information about my organization/business: <br />Name of organization/business: on d/lurch! <br />Ops E/ iCaAhir^t^ 6b Ofe/iton dA, <br />( ) —El. __C) (d (d I Alternate: ( ) x/8 ~7 " V V <br />List food to be sold or given to the public: honOh) lodfl C