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<br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8.the hot and cold holding of potentially hazardous <br />9. <br />cookod Loans, rico, <br />Page 7 of 11 <br />II Ml' I VI Ml AH' <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br /> On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's <br />Note: The only operations not required to provide enclosed booths <br />approved dispensers, or prepackaged foods from approved <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />=HD 16j)2 <br />7/14/15 <br />Address: Z A CSWlnl <br />Phone: ~~^~7 M 0 <br />List food to be sold or given to the public: kpfCfod <br />use: U Yesf^klo <br />I am providing an accurate probe thermometer to measure <br />foods during all times of booth operation: Yes'MNo <br />ISST: 109 f0ll0Wing hot temPerature control for the hot holding of all potentially hazardous foods above <br />4- 3579 <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 />Q 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 cieanable 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 />a signed and completed copy of this checklist to <br /> Date(s): 3*/,5 ~7//^) <br />are those which sell beverages from <br />sources. <br />Q Stereo & hotel trays <br /> Steam table & lids <br />D Other (specify) <br />NOK: food iododo: <br />eggs, and dairy products. <br />All food vendors (both for profit and non-profit) arc required to return <br />the festival coordinator three (3) weeks prior to this event. <br />I.Name of Event- "Va/moA'S O'Vi r_ hl? I---------- <br />The following is information about my organization./business: <br />Name of organization/business: HC WaT O 7-3--------- <br />__ Alternate: ( /Dcl ) <br />meats, tamales, <br />I am providing food that is NOT prepared at home: O Yes (3^No <br />All food is prepared on-site or is from approved commercial facilities: O Yes ^No <br />Name of facility: Phone: 1 <br />Address of facility: