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TEMPORARY FOOD VENDOR'S APPLICATION i <br /> All food vendors (bath for profit and non-profit)are required to return a signed and completed copy of this checklist to I <br /> the fesilval coordinator three(3)weeks prior to this event. <br /> 1. 1,Name of Event, Kite Festival, July 4, Aug MIP, Sept MIP Date(s) ti ,7-4,8-17,9-24 <br /> 2. The following Is Information about my organ lzatlonthusiness: <br /> ' f <br /> Name of organlzationfbusfness, Lvtv1.cJ Vie" <br /> Address: _ 16Uf <br /> Phone; (bT f ` � "G �l Alternate; ( 5 ) T`71,r' <br /> 3. List food to be sold or given to the public:.- f,��t1 <br /> 4. 1 am providing food that Is j�0 prepared at home: Q�Yes❑ No <br /> All food is prepared on-site or is from approved commercial facl)ttles: P Yes❑ No <br /> Name of facility: - 6 -_ phone: (- __1 <br /> Address of faclllty: <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from files, <br /> dust and the public) I . <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): <br /> Note: The only operations not required to provide enclosed booths are those which sole beverages from <br /> approved dispensers, or prepackaged foods from approved sources, <br /> 8. Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> ❑Approved bottled water. <br /> ❑On-slte hose bib that Is connected to a potable water source. r <br /> ®other(specify): 5 eft h c UW[1 At e,d' 0 <br /> 7. Electrlolty Is provided for my booth's use: IN Yss ❑ No ��f I el,,' e 04tv n44 <br /> B. I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous i <br /> foods during all times of booth operation: ❑Yes❑ No IjI <br /> 9, 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1 WF: <br /> Cl Camp stove ❑ Sterno&hotel trays f <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑Electric stove top ❑Other <br /> Note, Examples of potentially hazardous food Include; moats, lamales, cooked beans, rfco, <br /> vegetables,potato salad, eggs,and dairy products, <br /> r.HA 10.02 Page 7 of 11 TEMP EVENT APP <br /> 00101 rS 0 <br />