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S A N '111 P ".i f_I Environmental fied ii ueparttrwfa <br /> 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 thfs event. G� <br /> 1. 1.Name of Event: r Date(s): 3&S -2-14 <br /> 2. The following is information about my organ izationlbusiness: <br /> Name of organizationlbusiness: t/ <br /> Address: 6L( <br /> Phone: (47t 0 Alternate: ( ) <br /> r <br /> 3. List food to be sold or given to the public: 1( ` Ll `' <br /> 4. 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: �KYas ❑ No <br /> Name of facility: L" �'S Phone: ( fto) F�02,' 09-19 <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <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 /> 15�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. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use:Ayes ❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Ql�Pes ❑ No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑ Camp stove ❑ Sterno & hotel trays <br /> �"Qouble steamer ZSteam table&lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include. meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> 1868E Hazelton AV(-,:;.k } Sio.Y,tor, Cill;: ; o l.t - ) 4158-1920 1 F Ir.: 464-^1'18 j www. <br /> EHD 16-02 Pays'r c,f 11 TEMP EVEN F/!'f' <br /> 06/19/19 <br />