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RECEIVED <br />APR 1 0 201? <br />Date{s): I.Name of Event: 1. <br />n/business:The following is information about my organ<2. <br />(’ ft H ST Or <br />Address: <br />Phone.(2oq) <br />List food to be sold or given to the public:3.<Jt5'V <br />4. <br />flies,5. <br /> Other (specify): <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11 <br />CA °I6 3 76________ <br />EHD 16-02 <br />08/01/16 <br /> Stemo & hotel trays <br /> Steam table & lids <br /> Other (specify) <br /> A booth with wafls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It wifl also have a smooth and cteanable floor (concrete, <br />asphalt, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Name of facility: <br />Address of facility: <br />U|(Y <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 />OCtAiQUS <br />Alternate: <br />TEMPORARY FOOD VENDOR’S APPUCATO^ <br />Ail food vendors (both for profit and non-profit) are required to return a signed and completed to <br />the festival coordinator three (3) weeks prior to this event. <br />Note: Examples of potentiatty hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: Ej Yes No <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />TarrYV?________ Phone: gyO <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation ata <br />dust and the public) <br />Name of organization/business:___ <br />(r- |\ <br />Approved water for drinking, utensil and hand washing wifi be provided in my booth by the following methods: <br />^Approved bottied water. <br /> On-site hose bib thart is connected to a potable water source. .- . <br />Other (specify): 00 D <br />Electricity is provided for my booth’s use: □ Yes □ No | <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during aH times of booth operation: O Yes O No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: