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TEMPORARY FOOD VENDOR'S APPLICATION <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. 1.Name of Event: G� / -f� Date(s): �`� 1-7 <br /> 2. The following is information about my organization/business: <br /> Name of organ izationthusiness: Gt nfial <br /> �- P,1 � !`1 o <br /> Address: l'aU �1 c 'l I (� �• SCi f`� n <br /> Phone: ( quo) �32 - 23 51 Alternate: { ) <br /> 3. List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home: Yes ❑ No <br /> All food is prepared on-site or is from approved commercial facilities: WfYes❑ 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 foo <br /> dust and the public) dartaon areas from flies, <br /> ❑ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fscse mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanable f (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and hood preparation <br /> areas from the public. <br /> ❑ Other(specify).- <br /> Note: The only operations not required to provide enclosed booths are those which sel be ecages 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 to le fohmving methods: <br /> �pproved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source_ <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes ❑ No <br /> 8. 1 am providing an accurate probe thermo et r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operationYes❑ No <br /> 9, 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Sterno& hotel trays <br /> ❑ Double steamer ❑ Steam 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 /> �06I01I16 EHD 16-02 Page 7 of 11 <br /> TEMP EVENT APP <br />' � 7"gss[` <br />