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FOOD VENDORS PERMIT APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to the <br /> festival organizer two(2)months prior to this event <br /> 1. Name of Event `.-/(�C. Yll�il-<� /"/ —`--� a^K'r4. Dates}L� 'QK <br /> 2. The following is information about my organization/business: / <br /> Name of organizatior&usiness: <br /> Address: Po ' F}Qe X ��a f7 <br /> Phone: (�? ) UC/� Alternate:(c/-0) 0?3 <br /> 3. List food to be sold or given to the public: fS T C1s�%opt/ %N�15� �'r�GMiyl . I;l e F( xi <br /> 4. 1 am providing foods that are not homemade:❑Yes_o No 5 <br /> All foods are prepared on-site or are from approved commercial facilities:❑Yes IYNo <br /> Name of facility. Phone:( 1 <br /> E.H.Permit#. <br /> 5. 1 am protecting my unpackaged food and food-preparation areas from flies, dust and the public by the following <br /> methods: <br /> AA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening,completely enclosing open food areas. <br /> ❑A booth with a smooth and cleanable floor(concrete,asphalt,dean tarps and smooth wood are acceptable). <br /> ❑A booth constructed to separate food and food preparation areas from the public. <br /> ❑Other(specify): <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 /> 6. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water(Alhambra,Polar,Sierra Spring,etc). <br /> ❑Hose-bib on-site at the festival. <br /> ❑Other(specify): <br /> 7. Electricity is provided for my booth's use:❑YesDd"No <br /> 8. 1 am providing an accurate probe titer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:gYes❑No <br /> 9. 1 am providing the folk>wing hot temperature control for the hot holding of all potentially hazardous foods'above <br /> 140°F: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> Double steamer ❑Team table&Ids <br /> ❑ Electric stove top XOther(specify) <br /> Note: Potentially hazardous food examples: meats,tamales,cooked beans,rice,vegetables, potato salad,eggs <br /> and dairy products. <br /> EH 1602 Page 7 of 9 m w EVEN-err <br /> W 3 <br />