Laserfiche WebLink
TEMPL..ARY FOOD VENDOR'S APPLiC, ON <br /> /2. <br /> vendors (both for profit and non-profit) are requ red to return a signed and completed copy of this checklist to <br /> tival coordinator three(3)weeps prior to this event. <br /> Yl eg S�►J��� � 1 Date(sj ,fA � LAolel <br /> .Name of Event:�t' S-{-c.��� T__-�.The following is information about my crganizationlbusiness: <br /> Name of organization/business: __G_CY <br /> Address -1 <br /> Phone: . 531 _ .qa Z ly 56 Ahemate t 5.3i !?tw <br /> .�"SJ� �o <br /> List foc�,,o be sold cr g:ven to <br /> 4 1 am providing food that is NOT prepared at home.; Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes 0 No <br /> Name of facility. Phone f ) <br /> Address of facility: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies. <br /> dust and the public) <br /> DCLA 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 )A1,11 also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth mod are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Other(specify): <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 /> 6 Approved water for drinking,utensl and hand washing will be provided in my booth by the following m_thods: <br /> Approved bottled water. <br /> i_ , On-site hose bib that is connected to a potable water source <br /> D Other(specify)- <br /> 7. Electricity is provided for my booth's use:19Yes❑ No <br /> 8. ( am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazwdous <br /> foods during all times of booth operation:�Yes No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> fit � <br /> o stove 'Sterno& hotel tra;Is <br /> ❑ Double steamer 7, 1 Steam table&Bids <br /> E iecmc stove top qD Other(specfy) Deer! 'Fr jer% <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> -D 16-C2 Paige 7 Df 11 TEMP E'JEN7 AP'- <br /> 1;4!14 <br />