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i <br /> I <br /> i <br /> t <br /> TEMPORARY FOOD VENDOR'S APPLICATION <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 /> 1. 1.NameofEvent: jViy t_tu D4rry 44I)r_1SE !F6bDTr:_L4L_k'_ TZ10TrV S Date(s): <br /> 2. The following is information about my organization/business: <br /> Name of organization/business: L i)L-0 Z=r_ `l�f wr(atilC�`�IrLL� <br /> Address: <br /> Q 95JFc 4 <br /> Phone: )7L E-) Alternate: ( ) <br /> 3. List food to be sold or given to the public: fi PSE 0 <br /> i <br /> 4. 1 am providing food that is NOT prepared at home: [D1s❑ No <br /> All food is prepared on- ,te or is from approved commercial facilities: Pes[I No <br /> Name of fa 1i y( W&7 EL ASD 1 aLft-L LA/Pr Stf- Phone:()C <br /> Address of facility: ��, c�- C.`1 L_I F`,L- NIA- \( r _LA C)5 2L <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. `��• <br /> Other(specify): �.`� �%�a 1�_>•�"t LL�---� <br /> Note: The only operations not required to provide enclosed boore those which sell beverages from <br /> approved dispensers,or prepackag d fo om approved sources. <br /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> P-Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> Other(specify): -tt A11J0 LNf7 V +f-/A 6ii /moi !� <br /> 7. Electricity is provided for my booth's use:U-Yes❑No <br /> 8. 1 am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: PYes No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135'E: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑Steam table&lids <br /> i <br /> ❑ Electric stove top Other(specify) F.�V (_t; cOL—� 7D <br /> Note-, Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> i <br /> 63:i <br />