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TEMPORARY FOOD VENDOR’S APPLICATION <br />M. u-e r -fes Ave Date(s): !(o1. <br />2. <br />Address: <br />)Phone:) <br />Ill'll3. <br />4. <br />5. <br />6. <br />Other (specify): <br />7.Electricity is provided for my booth's use: Ye§) No <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />10.I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />Page8 of 13 TEMP EVENT APP <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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 />Camp stove <br />Double steamer <br />Electric stove top <br />Sterno & hotel trays <br />Steam table & lids__ > <br />Other (specify) <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 />EHD 16-02 <br />7/-1 >1f1C <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 />Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <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: 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 />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 Event: d-e. /os, <br />The following is information about my organization/business: <br />Name of organization/business: <br />[Il g. Sfrrf/s-r <br /> Alternate: ( <br />List food to be sold or given to the public: HOL. <br />I am providing food that is NOT prepared at home:^YegJ No <br />All food is prepared on-site or is from approved commercial facilities:No <br />Name of facility: M. da Fg i.d Phone: - / ‘7 3/ <br />Address of facility: t , A# 7