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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2. <br />Phone:Alternate: () <br />3.BguGAey-14- <br />4. <br />5. <br />those which sell beverages from <br />6. <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9. <br />meats, tamales, cooked beans, rice. <br />Page 7 of 11 TEMP EVENT APP <br />J^On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth’s <br /> Camp stove <br /> Double steamer <br />Q Electric stove top <br />J^Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Mote: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />-S~.4<v o, ,a7 <br />I he following is information about my organization/business: <br />2j3 <br />r <br />H<33 -8s 7g <br />usejxQYes No <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: CJ Yes Q No <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />EHO !6-02 <br />8/1/V <br />I am providing food that is NOT prepared at home: IZkYes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes No <br />Name of facility: ST Phone: (St’v ) <br />Address of facility: __ <br />□ate(s): <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <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 iestival coordinator three (3) weeks prior to this event. <br />1. Name of Event /"4ES7Z)- <br />' ^sT^d th9 3 bb|Ot)h W'th thS follOWin9: protect my unpackaged food and food-preparation areas from flies, <br />gjA 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 />Name of organization/business: n 3 <s- <br />Address: 2^^ (a/ Z-/v <br />(Z«<7 > 7 <br />List food to be sold or given to the public: