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r <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors (both for profit and non-profit) are required to return a sicned and completed copy of this checklist t:± <br /> the festival coordinator three(3)v✓eeks prior to tr ==nt. <br /> 1. 1.Name of Event: LEE, <br /> _►V Z;t.L_ Date's, <br /> 2. The following is information about my organizationibusiness- <br /> Name cf organization/business: e V <br /> Address 143Y7, FO ICA d t,'C(L2- <br /> 4 <br /> 3 List`clod to be sold or civen to the public. <br /> 4. 1 am providing food that is NOT prepared at home. *es❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes 1 <br /> Fume of facility: Phone f L <br /> Address of facility: <br /> 5. 1 am providing a booth with the follov✓ir,g: (to protect my unpackaged food and food-preparation areas from flies <br /> dust and the public) <br /> [$,A booth with walls and ceiling constructed of ether wood, canvas, plastic, simi!ar material and fine mesh fly <br /> screening. completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constricted to separate food and food preparation <br /> areas from the public. <br /> ❑ Other(specify): <br /> Note: The only operations rot required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 5. Approved water for drinking, utensil and hand washing will be provided in my booth oy the following methods: <br /> Approved bottled water- <br /> ❑On-site hose bib that is connected to a potable water source <br /> `I Other(specify): <br /> 7 Electricity is provided for my booth's use: I$1 Yes❑ No <br /> 8. 1 am providing an accurate probe thermometer to measure the rot and cold hoidirg of potentially hazardous <br /> foods during all times of booth operation:0�1 Yes C No <br /> 9. 1 am providing the following hot temperature control for the hot holding,cf all potentially hazardous foods above <br /> 135°F.- <br /> camp stove j Ste no& hotel trays <br /> Double steamer [j Stearn table&Gds <br /> ❑ Electric stove top ❑ Other(specfy) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs, and dairy products. <br /> 9MJ 15-02 Pane 7,-f 11 TEMP EVEN"A^-7 <br /> s.y4 <br />