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1. <br />2. <br />VAddress: <br />3. <br />4. <br />5i k <br />5. <br />6. <br />7. <br />8. <br />9. <br />135°F: <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 />other (specify) kJ o WA coj wedzd <br />meats, tamales, cooked beans, rice, <br />are those which sell beverages from <br />sources. <br />required to return a signed and completed copy of this checklist to <br />Date(s): ‘ I [_ <br />I am providing food that is NOT prepared at home: (S Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: £)!> Ookj Phone: (1 <br />Address of facility:___________________ _______________________ <br />Electricity is provided for my booth’s use: [&Yes No <br />I am providing an accurate probe thermom^er to measure the hot and cold holding of potentially hazardous <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 />1. Name of Event: <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 />Other (specify): SOz'faC'€S <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />LZJ Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />All food vendors (both for profit and non-profit) are i , ’ - - <br />the festival coordinator three (3) weeks prior to this event. <br />The following is information about my organization/business: <br />Name of organization/business: J /TllVLX Q <br />Phone: Alternate: ( <br />List food to be sold or given to the public: / yVtV cUq>C <br />TEMPO^RY FOOD VENDOR’S APPI^ATION <br />>