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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event. <br />2. <br />Address: <br />Phone. <br />3. <br />4. <br />5 <br />6 <br /> Approved bottled water. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />7/14/15 <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> Camp stove <br /> Double steamer <br />"fij Electric stove top <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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: H Yes No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F: <br /> On-site hose bib that is connected to a potable water source. <br />Other (specify):. lcvkWiA M 5)^ <br />Electricity is provided for my booth's use: Yes No <br />I am providing food that is NOT prepared at home <br />All food is prepared on-site or is from approved commexpial facilities: S Yes No <br />Name of facility: ‘ 1 <br />Address of facility \t>5g $■- <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 /> 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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods' <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 />Far/n ft? Date(s). <br />The following is information about my organization/business' <br />Name of organization/business:. <br />PtfARc s-toct-ha) Ok <br /> Alternate ( )_ <br />List food to be sold or given to the public 8^4(1 life/ <br />Yes No <br />red commexpial facilities: M Yes No « ■ <br />(gMtl WtyMjj Phone GG-Sot | <br />M r ptA- my "T+nct-ton j 7^