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ZA <br /> W W -21 WrM I 7h rA <br /> 2 <br /> M ,yam► }�.� �► __!►,�_ !�!Md_ !► __,rte► . <br /> �l _.�d____l�_ <br /> i <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> 1 <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. h 1 <br /> 1. 1.Name of Event t '"fir 14 rws e +va c< <r Oate{s) ►Z i <br /> 2 The following is information about my organization/business: <br /> ► i <br /> Name of organization/business: 1f�-11Y11 S—�r�(A 1am(}ISI r jC Y 1 <br /> wAddress: �1�1,r1 C. 4ej tC r Of 0Zt 1-1 L �)`i C_ <br /> Phone: (SIO) 9` )7 Alternate <br /> ~ 3 List food to be sold or given to the public:j 111), s cv 'ti = InZ r�rrl 11 t'S r ! I�tr F P l ST'r2i <br /> q. 1 am providing food that is NOT prepared at home.P Yes❑No ' <br /> All food Is prepared on-site or is from approved commercial facildies:V Yes❑No <br /> Name of facility: —t �f n Phone;(LAS) h F L-0lq 1 <br /> Address of facility: CICL_LIN-101,11 <br /> �� 11(1111 rL�n f fr <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. I <br /> ❑Other(specify): <br /> 4 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 /> ❑Approved bottled water. i <br /> ❑On-site hose bib that is connected to a potable water source. j <br /> ❑Other(specify); <br /> r <br /> f 7. Electricity is provided for my booth's use:(]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: ❑Yes❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous(Dods above <br /> 135°F: <br /> 1 <br /> ❑Camp stove ❑Stemo&hotel trays i <br /> H ' <br /> ❑Double steamer -flSteam table&fids i <br /> ❑Electric stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, } <br /> ., vegetables,potato salad,eggs,and dairy products. <br /> 8 <br /> Elib t6-02 <br /> P490 7 of 11 TEMP EVENT MP <br /> OBNNIG <br /> T <br /> i <br /> I <br /> S <br />