Laserfiche WebLink
t <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 /> 1- 1.Name of Event: <br /> Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organizationibusiness c— <br /> j <br /> Address: ^�/ <br /> Phone: (��`)��C�•—�S r � � Alternate: <br /> 3. List food to be sold or given to the public: <br /> 4. I am providing food that is NOT prepared at homeZyeS❑ No <br /> All food is prepared on-site or is from approved commercial facilities: /yes❑ No <br /> Name of facility: �,p i�/������� <br /> Address of facility: Phone: r 2-6q <br /> 5. 1 am providing a booth with the following:(10 protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> `booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine m <br /> /screening, completely enclosing open food areas. It will also have a smooth and cleanable mesh fly <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food prepa ation <br /> areas from the public. <br /> ❑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 /> 6• Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> ZEJ"Approved bottled water- <br /> POn-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: Yes ❑ No <br /> B. 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 [I No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'F: <br /> ❑ Camp stove <br /> ❑ Sterno&hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top �Z Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> EMD 16-02 <br /> 0a/01i16 Page 7o 11 <br /> TEMP EVENTAPP <br /> d <br /> ,4 __ <br />