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i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Date(s): <br />2. <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify);A <br />those which sell beverages from <br />6. <br />Fe» * J <br />Io <br />9. <br />meats, tamales, cooked beans, rice, <br />TF^'P EVENT APP <br />7. <br />8. <br />563 5. l-i <br />EHD 16-02 <br />06/29/2023 <br />V, r h . <br />No <br />) <br />U '"V___________________________ <br />______________________ <br /> Alternate; ( ) ^ / C — S 6 <br />pr-cj _________ <br />A <br />CAN ] <br />NOT prepared at home: Yes No <br />incite or is from approved commercial facilities: Yes 0 <br />G4-P V Phone: £ <br />required to return a signed and completed copy of this checklist to <br />'S(7^y_5 <br /> On-site hose bib that is connected to a potable water source. <br />□ Other (specify):fv/ <br />Electricity is provided for my booth's use: Yes No ' 1 <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />roods during all times of booth operation: Yes No N /p o ✓ V-> - J F / <br />I am providing the following hot temperature control for the hot'holdirg GraFpdtentialM hazardous foods^above <br />135 F; l\l/h- 1 <br /> Camp stove Stemo & hoteFtrays y <br /> Double steamer Steam table & lids <br /> Electric stove top other (specify) <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is <br />All food is prepared oi <br />Name of facility: L <br />Address of facility:C Y~O — Co ~ <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flie« <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 />areasVom the pubKcarid SmO°th W0°d are accePtabte) and constructed to separate food and food preparation <br />w/ Pr <br />Psge 7 of 11 <br />Note: The only operations not required to provide enclosed booths are <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 /> Approved bottled water. <br />All food vendors (both for profit and non-profit) are ‘ <br />the festival coordinator three (3) weeks prior to this event <br />I.Name of Event: HQijfiTfyN HCUSB <br />The following is information about my organization/business: <br />Name of organization/business: b <br />Address: <br />List food to be sold or given to the public: