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TEMPORARY FOOD VENDOR'S APPUCATION <br /> Al 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 threie—(3)ws�ee�kss prior t t�oo this event. <br /> 1• 1.Name of Event: �"`� � �" Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organizabontbusiness: <br /> Address: YV� /fe <br /> Phone: (a(�) [ 4 7 `l(ga{ Alternate: ( ) !)( <br /> 3. List food to be sold or given to the public: Sh&L Amj <br /> te_ v <br /> 4. 1 am providing food that is NOT prepared at home: M Yes❑ No <br /> All food is prepay on-site is from approved commercial facilities: 04s❑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 h walls and ceiling constrUOP- {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 /> [Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑Other(specify): <br /> 7, Bectricilty is provided for my booth's use: ❑Yes D No <br /> 8. 1 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 Y No <br /> 9. 1 am providing the following hot temperature control for the hot holding of ail potentially hazardous foods above <br /> 135°F. <br /> ❑ Camp stove ❑ Stemo&hotel trays <br /> ❑Double steamer ❑°''.eam 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 /> EHD 145-02 Pace 7 of 11 TE?AP EVENT APP <br /> 7/14115 <br />