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(o Y <br />1. <br />2. <br />Address: <br />3. <br />4. <br />5. <br />6. <br />9. <br />All food vendors (both for profit and non-profit) are required to return <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br /> Stemo & hotel trays <br /> Steam table & lids <br />pother (specify) VA P <br />meats, tamales, cooked beans, rice, <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 />135°F <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br /> Date(s): \the festival coordinator three (3) weeks prior to this event. <br />The following is information about my organization/business. <br /> <br />Name of organization/business. 1—_r------- a -------------- <br /> fay4-______ <br /> Phone: ------------------------- Alternated ) ----------------- -------------- <br /> <br />LBt toed to be sold or given to the public: <br />I am providing food that is NOT prepared at horned Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes O No <br /> Name of facility: ----------------- Phone: (^) W---------------- <br />Address of facility: ---------------------- ---- ------------------ <br />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 /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine <br />screening, completely enclosing open food areas. It will also have a smooth and ^nab'eJ^ <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. \ t ' 1_ <br />'^OtherTooA ------------------------------------ <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 />T<1 Other (specify): Y~~V LA _ ______________ <br />7. Electricity is provided for my booth’s use: Yes ^No <br />8. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous