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1 . <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(Wh for proftt and non-profit)ara required to return a sighed and completed copy of tWs checklist to <br /> the festiyai coordinator three(3)weeks priolcr fhla R,nnt <br /> t• 1.tVameof Event: � l'� .`I p:�i _Date($); <br /> 2. The fallowing is in6mauon about my orgFin izab4nlbusiness: <br /> Nanta of organ lzationlbusiness: 0 ens <br /> Addnass: S 7 <br /> Phone: <br /> Alternate:( I <br /> 3. fist fond to be sold or given to the public: 3 ! <br /> I <br /> 4. {am providing food that is MOT prepared at home:❑yes R <br /> All food is Prepared on-sfte or is m i <br /> A rov commerri cilitiEs: Yes Alp <br /> Name of facitity-, <br /> Address of facility. Phone: <br /> S. }am providing a blit) with the faltawtng: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> Sc 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 (coriaete, <br /> asphalt,clean tarps and smooth wood are acceptable)and constructer!to separate food and food preparation <br /> areas from the Pudic. <br /> [)(Other(specify); <br /> Note: The only Operations not required to provide enclosed oths are t se ch sell bev rages from <br /> approved dispensers,or Prepackaged foods from approved sources. <br /> 6. <br /> Approved water for drinking,utens4 and hand washing will be provided in my booth by the fat;ov ing methods: <br /> �aved bowed water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑GdrBr f s # <br /> p�Y) <br /> 3 <br /> l <br /> y. Electricity is provided for my booth's use: Yes&trio i <br /> i <br /> B. L arp providing an accurate probe thermometer to vasure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation:❑Ye <br /> SXM0 . <br /> 9. 1 am providing the following hot tomperature control for the hot holding of all potentially hazkudous foods above <br /> i <br /> 1V , <br /> Q Camp.stove ❑sterno&hotel frays 1 <br /> El Daubls.steamer O Steam table&lids <br /> ❑Electric stove top ❑Other(specify) <br /> Notal. Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, a <br /> vegetables,potato salad,eggs,and dairy products. <br /> EHD 16-02. Psge 7 of S 1 TEUP EVENT'W <br /> Oa'GtJ4b. ' <br /> _ i <br />