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SA N.=--t10AQ U IN Environmental Health Department <br /> �ILrcaFN\P', Greatness Qrovys here. <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: Lf>t' /k9; llJer�/ Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organ ization/business: �j-J/L (S F/LU� �W-DS <br /> Address: �� �al/e/�J G���' �Q11e , `vfOGPS� : a q-k-3 <br /> Phone: Alternate: ( ) <br /> 3. List food to be sold or given to the public: �%�S <br /> 4. 1 am providing food that is NOT prepared at home:P9 Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities:�Yes ❑ No <br /> Name of facility: Phone: ( ) <br /> Address of facility: <br /> 5. 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 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): <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 /> SjrApproved bottled water. <br /> ❑ On-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 o <br /> 8. I am providing an accurate probe thermomet o measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes ❑ No <br /> 9. 1 a providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 35°F: <br /> amp stove �stemo &hotel trays <br /> ❑ Double steamer ❑ Steam table& lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 1QFQ G Wn,nitnn A­mn,,c I Q+^,W^n (`olifnrnio Qr,')1r. I T ')A0 AFQ_4A7r1 I C 7r10 ARA J)l QQ I uninu n�nnv nrn lcn Lrl <br />