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( ' '4 <br />urn a signed and comol <br />1.I.Name of Event:Date(s): <br />2,The following is information about my organization/business: <br />Address: <br />Alternate: () Phone: <br />List food to be sold or given to the public: 3. <br />4. <br />1 <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />.pproved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />es NoElectricity is provided for my booth's use:7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />() <br />/tzTCamp stove <br /> Double steamer <br /> Electric stove top <br />^Ef^terno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />EHD 16-02 <br />7/14/15 <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 />I am providing food that is NOT prepared at home: <br />immen <br /><4 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit and non-profit) are required to return a signed and comoleted copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. ___ j , <br />* - Date(s): <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />'20 W btfrh.S <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Name of organization/business: <br />W a/ <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operationSWYes No <br />'es No <br />All food is prepared on-site or is from approved corhmercial facilities: YesJipJo <br />Name of facility:Phone: ( <br />Address of facility: