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TEMPORARY FOOD VENDOR’S APPUCATOH <br />1. <br />2. <br />3. <br />\ 4. <br />S. <br />6. <br />.H^Vi^-O^t*^**^**** <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, Kies,Etote:( <br />TCMP EVENT APPPago 7 of I'lEND ia-02 <br />-fizmo <br />" Phono: (hpl) .Sj^JlSTSx— <br />List food to ba sold orgfeen t<?ihe public: <br />I am providing food that is MOT prepared at home: Yes QlNo <br />All food is prepared on-site or is from approved commercial-Mitiss: JM-Yes [J No <br />\ Name of facility: ,,, ...,X- > ~ <br /> Address of facility _ _ ___——------—— <br />I am providing a booth with the followirij):.(to 'pratoct unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />IK1 A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine-mosh fly <br />Swnina comDleteiv enclosing open food areas. It will also have a smooth and cleanable 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 /> Other (specify): ______—-..........— ——------------------ <br />Mote: 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 />^1 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />|y| Other (specify): -----—--------- <br />Electricity is provided for my booth’s use: IJ Yes ®. No <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 |J No <br />I am ^dfog the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T://n Camp stove IJ Stemo & hotel frays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) <br />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 />tName of EventodS^^^ .SCL7 ‘ 1 <br />Th® following-fe information about my orgartofion/business: <br />Nameoforganfrtation/busih&ss:„iW^£i..J^^5?^J..^^Q^..AX^^---- <br /> l££---- <br />Altehate: —