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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): TY\£- •fiMxMI.Name of Event:1. <br />The following is information about my organization/business:2. <br />Name of organization/business: <br />Address: <br />Alternate: (Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: E3 Yes No7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <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 />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 /> Sterno & hotel trays <br />[3 Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />p/vo, Ofc <br />('I 2.5) fc^io- 'tS'TS \ <br />'DCll-1 0550 TfrVA* L'-l fWjfA <br />^5350 <br />ra 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 />I am providing food that is NOT prepared at home: Q-Yes No <br />All food is prepared on-site or is from approved commercial facilities: Q Yes No <br />Name of facility: figuJoSSo fwAii-v Phone: (?Z5 ) c 1 <br />Address of facility: Sot ■ATp/Tc-f, CA ______________________ <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />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: Yes No <br />) <br />List food to be sold or given to the public: HoV t Souf, ^-,zy/y'> V-tAhc -lyev SfrifF