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t <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 this event. Saturdays <br /> ! yf /� Year Round <br /> 1. 1.Name of Event. �1~ �C l.� E7'�€� ��(J. G�� N�Ac"l��4' � �Date{s). <br /> 2. The following is information about my organ ization/busiiness'. <br /> Name of organizationlbusiness: , +�,-4 _ q <br /> Address \©`� g(Lomsoj 131- -f G �AN t A �� �/L— `j' ', L4; L , <br /> Phone: ( j� )_L{ 23 `7_`f Zr Alternate:( l ) f G7 y <br /> 3 List food to be sold or given to the public: rl�(t-A C,I s 'N I- i (- AJ{ I A L I <br /> F f A C v t o 4—t- D CqC G L) <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: [ 'Yes❑ No <br /> Name of facility: C'C�L!­[t\1.IW S 'F� t` f" �'-Y Phone: ,- ✓l <br /> Address of facility: 11C1_1 A 13 d \` l <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 /> booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> creening, 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 /> NJ Other(specify): i' A C k 6� <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 /> 0 Other(specify): _PO T A 6 L-L (AjPa-1 L <br /> 7. Electricity is provided for my booth's use: ❑Yes n No <br /> 8. 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: aYes ❑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 IV ❑ Sterna&hotel trays <br /> ❑Double steamer ❑ Steam 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 /> EHo 16-02 Pn;c'01 11 7 EMP EV£N I APP <br /> 08/01/16 <br />