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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Address: <br />Phone; <br />3 <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />M Stemo & hotel trays <br />^jSteam table & lids <br /> Other (specify) <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 />Date(s); <br /> On-site hose bib that is connected to a potable water source. <br />pother (specify); V'J I [ | Qk) I (jO Ol-l K C) VXj K") <br />Electricity is provided for my booth's use: 0 YesT^No <br />O 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 cteanable 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 />[£j Other (specify); HR I <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 />Alternate: <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, Name of Eventr-i efeAT Da fooQicv &sv <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 operatiom'^Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />The following is information about my organlzation/business: <br />Name of organization/business: 'Dm ftujrmefis <br />LD CDfcSTA VDAv| <br />(________ ____________ ___ <br />List food to be sold or given to the public: <br />I am providing food that is NOT prepared at home's^ Yes No <br />All food is prepared on-site or is fromapproved commercial facilities; H-Yes No <br />Name of facility: U Di OK) " \ gUCJD Phone: <br />Address of facility: | Q (*7 4TT _____________________