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1 <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. <br /> 1. 1.Name of Event: �''UlL1JJI Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organ ization/business:-\;?-)kk�L� <br /> Address: `� y ✓" `� � V` <br /> Phone: o v L�`` � Alternate: <br /> 3. List food or oven to the,public. v � �. �• <br /> 4. I am providing food that is NOT prepared at home: Yes❑ Na <br /> p ,J <br /> All food is prepared on-site or is from approved commercial facilities:lm Yes❑ No <br /> Name of facility: Phone: ( ) <br /> Address of facility: <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 /> Y <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> eening, 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 /> ❑ 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 /> 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 /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: [n Yes❑ No b4q. k j !�, ' *5qwf?�K Ike <br /> 8. 1 am providing an accurate probe thermom ter to measure the hot and cold holding of potentially hazardous ' <br /> foods during all times of booth operation: „Yes ❑ 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 ❑Sterno&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> lectric 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 Page 7 of 11 TEMP EVENT APP <br /> 08/01116 <br />