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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event1.AL <br />2. <br />Address:H- <br />Phone:) <br />3. <br />4. <br /> Other (specify): <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 />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the pub'iic) <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 />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: Q Yes No <br />Q Stemo & hotel frays <br /> Steam table & lids <br /> Other (specify) <br />Q Camp stove <br /> Double steamer <br /> Electric stove top <br />List food to be sold or given to the public: <br />V Cl <br /> Other (specify): <br />Electricity is provided for my booth’s use: Yes Q4fo <br />Date(s): Win a. <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. Jf will also have a smooth and cteanabie 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 />Note: Examples of potentially hazardous food include; <br />vegetables, potato salad, eggs, and dairy products. <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 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />The following is information about my organization/business: <br />Name of organization/business: r <br />I erm provfomg food Wtaf is HOT prspared at home'. 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: L_f Yes O No <br />Name of facility: G x A.c C<1 Phone: [1 <br />Address of facility: y <br /> Alternate: (