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TEMPORARY FOOD VENDOR'S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />1. Name of Event: 5-z-0 c.-i&t..Jc): t3/,Ac-K, Date(s): citZ <br />The following is information about my organization/business: <br />Name of organization/business: <br /> <br />As A-Frz_t_ L <br /> <br />Address: 47 ie. C-0Skcv c9 5I 5 <br />Phone: (221 ) Alternate: ( <br /> <br />List food to be sold or given to the public: <br /> <br />r—s ) s-Sorto...5 <br /> <br />I am providing food that is NOT prepared at home:.Yes El No <br />All food is prepared on-site or is from approved commercial facilities:. Yes No <br />Name of facility: Phone: ( <br />Address of facility: <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 />10 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 />1.-er1h-j- (specify): -Ft7Z7 <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 />Approv d water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br />Other (specify): <br />Electricity is provided for my booth's use: 4es 0 No <br />I am providing an accurate probe thermomete to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: es 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove Stemo & hotel trays <br />Double steamer <br /> 0 team table & lids <br />Electric stove top <br /> E'Other (specify) -pet:, <br />Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products. <br />EHD 16-02 Page 7 of 11 TEMP EVENT APP <br />7/14/15