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TEMPORARY FOOD VENDOR’S APPLICATION iF(1^'1 i' i c-'1.I.Name of Event: 2. Phone: 3.List food to be sold or given to the public:2? -s 4. 5. Other (specify): 6. IZI On-site hose bib that is connected to a potable water source. Other (specify): Electricity is provided for my booth’s use: [J Yes No7. 8. 9. meats, tamales, cooked beans, rice, Page 7 of 11 TEMP EVENT APPEHD 16-02 7/14/15 [3 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation areas from the public. Note: The only operations not required to provide enclosed booths are those which sell beverages from approved dispensers, or prepackaged foods from approved sources. I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, dust and the public) Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: 0 Approved bottled water. Sterno & hotel trays Steam table & lids Other (specify) J -7-c/z 0 Camp stove Double steamer Electric stove top 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. Note: Examples of potentially hazardous food include: vegetables, potato salad, eggs, and dairy products. I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above 135°F: Date(s):^t/g t / 3 <3 The following is information about my organization/business: Name of organization/business: ^4. /YaryS Address: < q/cx js h * /1 I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous foods during all times of booth operation: 0 Yes No 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: 0 Yes No Name of facility:Phone: (). Address of facility: o -P S'!xjmp'-j- ^€>>1 <2 Ku ______ Alternate: - 7*^ 5" 6) de Cc/e / /v i/a s A Lr7 S