Laserfiche WebLink
TEMPO[ 2Y FOOD VENDOR'S APPLIC 'ON <br /> ,qll food vendors (both for profit and nonprofit) are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event Ll <br /> t <br /> 1.Name of Event: _ CC i` AY L 'I Date(%): <br /> 2. The following is information about my organizationlbusiness: r y� <br /> f��clS�/� <br /> Name of organ izationlbusineys�s:: <br /> Address: <br /> Phone: "a Alternate: <br /> 3. List food to be sold or given to the public: "�e <br /> 4. 1 am providing food that is NOT prepared at homer Yes I l No <br /> All food is prepared on-site or is from approved commercial facilities:Y ' Yes F1 No 3 Z, � <br /> Name of facility TI-A. ,1 �C - � Phone: ' <br /> Address of facility: �'N�"�- - <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 /> ❑ 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 cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. r <br /> Other(specify): 0✓t L�' J ! ti-cti <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, utensil and hand washing will be provided in my booth by the following methods: <br /> El Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes Qo No <br /> 8. 1 am providing an accurate probe thermometer to rrWasure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑ Yes No JAX/ s _ <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> L] Camp stove ❑ Sterno &hotel trays <br /> El Double steamer ❑ Steam table &lids <br /> [ ] Electric stove top [ Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, mice, <br /> vegetables, potato salad, eggs,and dairy products. <br /> EF�LJ 1B Q, <br /> Page,/of 11 TEMP EVfi.NT AW <br />