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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, Kite Festival, July 4, Aug MIP, Sept MIP Date(s 6-1,7-4,8-17,9-24) <br />The following Is Information about my organization/business; <br />Name of organization/business; 5,1LoW 1U a (71, <br />Address; 'Ju l A-144,e4,/ 0-4,11AN 61:1- <br />6 .5" o 5.15v - 0 7 /..c." <br />Phone; 015 ) 7 7 ti Alternate: (6 ) 6 6 6 — 76 <br />3, LIst food to be solder given to the public: 5 k ct-1) 6 <br />4, I am providing food that is ISla prepared at home: 17 Yes 0 No <br />All food Is prepared on-site or is from approved commercial facilities; ip Yes 0 No <br />Name of facIlity: "- 0 - 61J1 r E 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 />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 />0 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods; <br />0 Approved bottled water. <br />0 On-site hose bib that Is connected to a potable water source, <br />DKI other (specify): 5 01 - es e,k4/[ciAue:Ad 14,04 b 5 r• ;;L-.44,1 <br />kiv ; t^ttg,4...e4- <br />Electricity Is provided for my booth's use; Yes 0 No )i III, vide, 04 , <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 operation: 0 Yes 0 No <br />9, I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />136°F: <br />0 Camp stove Sterno & hotel trays <br />0 Double steamer 0 Steam table & lids <br />0 Electric stove top. ID Other (specify) <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br />vegetables, potato salad, eggs, and dairy products, <br />END 16,02 Page 7 of 11 TEMP EVENT APP <br />00101(10