Laserfiche WebLink
TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s); 1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />CA N e <br />6. <br />8. <br />9. <br />a/a <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APPPage 7 of 11 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />: )________________:___ <br />EHD 16-02 <br />7/14/15 <br /> Other (specify):_ . ......... ......... .......................... <br />7. Electricity is provided for my booth’s use: Yes^ No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />Note: Examples of potentially hazardous food Include: <br />vegetables, potato salad, eggs, and dairy products. <br />foods during all times of booth operation:^ Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />The following is information about my organlzation/business: <br />Name of organization/business:-SAl fi'X M D t <br />S/T e frT?, <br />Phone: (/2D°I ) 68-S 6^0^ Alternate: ( <br />List food to be sold or given to the public: (r ts <br />I 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: , __________________________ Phone: (------1 <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 />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 />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Xl 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 />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 />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. I I 2^ <br />, me PCTnM-t t, Da[e,s):