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TEMPORARY FOOD VENDOR’S APPUCATtON <br />i. <br />2. <br />) <br />3 <br />6. <br />6. <br />7. <br />8. <br />meat*, tamataa, eaakad toaana. rice. <br />TEMP EVENTMpZoTH <br />fttt-04-12 17:23 Page 2/3 <br />END1M2 <br />W1M» <br />Approved water for dunking, utensil end hand washing Mdl be provided in my booth by the foAowing methods; <br />Q^pproved bottled water. <br />Note: The only operations not required to provide endooed booths are those which set beverages from <br />approved dispensers, or prepeckaged foods from approved sources. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br /> Steam table & Ids <br /> Other (specify) <br /> On-site hose bib that m connected to a potable water source. <br /> other (specify): _______ <br />Electricfty is provided for my booth's uea. Yes EJ^o <br />AD food vendor (both for profit and non-profit) are required to return a signed and completed copyx»f We chackllst to . <br />Note; Examplea of potanttaHy hexerdou* food Inatudo: <br />vogetebleo, potato aated, eggs, and dairy products. <br />the tes&vai coonUnator three (3) weeks prior to this event <br />N»™"fEV* fAl^^P-S WAAgfe-gF <br />I am provkfing an accurate probe thermometer to measure the hot and cold holdfog of potentially hazardous <br />foods during al bmee of booth operation: Yes &NO <br />I am providing the following hot tempereture control for the hut hoitsng of an p«entiaBy hazardous foods above <br />135’F: <br />The foltowing Is foformatlan about my organizatfonfoustoess: <br />Name of organoMtanfousiness: 0^-/ €>/A L SA-i/C <br />Phone: ( Alternate: ( <br />uat food to be sold or given to the public: <br />I am providfog food that Is HQT prepared at home: t^Yesn No <br />All food ii prepared orvstta or is from approved cmnniantel tacMes. <br />N«ne of facility: — <br />Addrewcffacgrtv.^.^ OO to • &LX)T" <br />y’Yae UNo <br />t ~ AA&1M f C4 <br />I am provMfog a booth with the following: (to protect my unpackeged food and food-preparation areas from flies, <br />dust and the pitfc) <br />[^Xbooth vfth walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screenfog, completely enclosing open food areas. It wV also have a smooth and deanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) end constructed to eeperste food and food preparation <br />areas from the public. <br /> Other (specify):................................