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TEMPORARY FOOD VENDOR’S APPLICATION <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APP <br />7. <br />8. <br />Phone: ft C Sz <br />List food to be sold or given to the public: 1> < V / <br />the hot and cold holding of potentially hazardous <br />p ' if ; <br />- - •> <br />I n ?, r:'1! \i <br />haz <br />EHO 16-02 <br />0&’29/2023 <br />Ej On-site hose bib that is connected to a potable water source. <br /> Other (specify): _______________ <br />Electricity is provided for my booth’s use: Yes-O No ---------------------- <br />I am providing an accurate probe thermometer to measure 1 <br />foods during all times of booth operation: Yes p] No ( , r <br />' an? proving the following hot temperature control for the hot holding of all potential'ly'hazardoGs"foods above <br />loo r: l 1 / n*\ <br />Q Camp stove Q Stemo & hotel trays ' <br /> Double steamer Q 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 />p •. I <br />■ • M i < J <br />All food vendors (both for profit and non-profit) are r_ <br />the festival coordinator three (3) weeks prior to this event. <br />1. <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 />^Approved bottled water. <br />required to return a signed and completed copy of this checklist to <br />1. Name of Event: UFfa Date(s): <br />The following is information about my organization/business: <br />Name of organization/business: _ <br />I ( Cb i A jp G> 3 _______ <br />< 2 Alternate: ( 2^ ) 5 S I (T £ <br />I am providing food that is NOT prepared at home: Yes [XI Nn ' 0 ft ?7Z <br />All food is prepared on-site ons from approved commercial facilities: Yes No <br />Name of facility C Qq ,phone. ( } <br />Address of facility: <br />1 T p/ovi?i'?9 a b00th with the lowing: (to protect my unpackaged food and food-preparation areas from flie« <br />dust and the public) <br />3.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 />aXs from the pubHc31101 SrnO°th W00d are accePtable) and constructed to separate food and food preparation <br /> Other (specify): <br />ifs 5205 ■ 468-3421" e 2C <br />Page 7 of 11