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TEMPORARY FOOD VENDOR'S, APPLICATION <br /> All food vendors (both for profit and Port-profit)are required to return a signed and compieted copy of this checklist to <br /> the festival coordinator three(a) ;v,,eeks pdor to this C_,ent <br /> 1. 1 Name of Eve,,. <br /> 2. The following is irforrnation about my organization/business /{ S !o • a �;L ' <br /> Name Cf C'g8n128tQr1'bne55' <br /> Address- a16 �r T --_ - <br /> I,, - - -__ K � 77 <br /> Phone: ( 410) U/ 7� g / D "'_ _T — <br /> jt L,st`pod to be sold or given to'he put'_ <br /> - :am prcviding food that is NOT prepared at home, Yes ( ] No _ <br /> All food is prepared on site or is fr= approved co•nmercia!faclTfties: Yes No <br /> Name cf facility. <br /> Phone ( i <br /> Address of iacility: <br /> I am providing a booth with the following: (to protect my unpackaged food and food- - aration are- f is <br /> .ist and the public) pep ds from f,r s <br /> KA booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh ry <br /> screening, completely enclosing open food areas It will 81SO have a smobth and cleanable floor (concrete, <br /> asphalt, clean tarps and smacth woad are acceptable) and con <br /> areas from the public, structed separate arate food and food preparation <br /> ❑ Other;specify}: <br /> Note: The only operations not required to provide enclosed booths a.fe those which sell bevera Q approved dispensers, cr prepacaged foods from approved g,s `rpm <br /> . pp. d sources. , <br /> Approved water for drinking, uten§ij and nand Vv2s'^ing ml'be provided in my booth oy the`oi!oZing methods. <br /> Approved bottled water. <br /> Q Orr-site hose bib that is connected to a potable,eater source <br /> `,:1 Other(specify):_ <br /> Electricity is provided for my booth's use�<Yes C' No <br /> 3 1 am providing an accurate probe thermometer to ,measure tare "ot and cold "olding of potentially hazardcus <br /> foods during all times of tooth cperaticn: Yes [No , <br /> 9. 1 am providing the following hot terperature contrel for the hot holding of all potentialif hazardous foods obeys , <br /> 135'F: <br /> L�J Camp st <br /> ove []Stemo& i-atel tra.,rs <br /> C Double steamer ❑Stearn table&6ds <br /> Electric stove tcp ❑ Other(sperlry) <br /> Note: Examples of Potentially hazardous food include: meat <br /> vegetables. potato salad, a s, tarna!e„ cooked beans, rice, <br /> ggs, and dairy products. <br /> amo 15-01 <br /> •�'a't< boat 7 cif 11 <br /> TCy1P EVV T Ann <br />