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the festival coordinator three (3) weeks phuf iu iiiis event <br />1.Name of Event: <br />2. <br />Address: <br />Phone: <br />3.List food to be sold or given to the public: <br />4. <br />5. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br />7. <br />8. <br />7. <br />meats, tamales, cooked beans, rice. <br />TEMP EVENT APRPage 7 of 11EHD 16-02 <br />10/13/09 <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: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />TEIMIDfiDADV mnn Y/Ckinnn’O a nm ir*ATir\t.i viw-iim ■ t unwvi\u nrruiuM i ivn <br />or <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 />I I r Af-'fw/l V/ V UZWlUVxVI . <br />[\£)Dn-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes^^^No <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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135“F: Kf I K <br /> Camp stove I <br /> Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: £p/Ves No <br />All food is prepared on-site ords from'.aoproved commercial facilifies'SzOt'es rj Nn <br />Name of facility: ^"phone: (/^7) ~~ $^9^^ <br />Address of facility:^__________________________ <br />required to return a signed and completed copy of this checklist to <br />r <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 />acnhalf rlaan lame anH cmnnth vA/r-wirl arc ar-r'cmfoKlaX anrl rnncfn irtari fn camrofa onH ortanorati/in <br />areas from the public. <br />M Other (specify): <br />f • ■ --------------------------------- <br />All food vendors (both for profit and non-profit) are <br />The following is information about my organization/businessz- <br />Name of orqanization/business: <br /> Alternate: ( )