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i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br />Ll On-site hose bib that is connected to a potable water source. <br />the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APP <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 />7. <br />8. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />■ 563 E I Ip/olir-n A <br />EHD 16-02 <br />06/23/2023 <br />.<09 ! ?■ y- 1 46 :1 <br />H : A 0 I II Ji; AU I J: <br />ij.a | 'o -■- j - i, C-alifu ■' 95 j >5 <br />Page 7 or 11 <br />p A k! <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth's use: Yes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: O Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135^: <br /> Camp stove Sterno & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />, S>- <br />bi <br />The following is information about my organization/business: <br />Name of organization/business: A a n (] ,, <br />r’ A/z 4 rV15 < wtl <br />Phone: () '4 ) / - V l'l 3 <br />List food to be sold or given to the public: A Ay ' <br />J/m providing food that is NOT prepared at home: Yes 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 />dustpnd the public) <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />Datets): <br />•he festival coordinator three (3) weeks prior to this event. <br />I.Name of Event: Wk <br />Lf 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.