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w <br /> SAl <br /> TEMPORARY FOOLS VENDOR'S APPLICATION <br /> All food vendors(both for profit and no-pto�io this required to return a signed ar$d cr)mpleted copy of this checklist to <br /> the festival coordinator three(3)weeks <br /> d o f h f 1 oate(s}: a 0,-, zS <br /> 1. 1,Name of Event <br /> 2. The following is information about my organizaborvbuslness: <br /> Name of organizationlbusinesstA ` <br /> Address: _ 2.1 2 o 1�1>1t4IA _ <br /> Phone (Z�) <br /> g�-[t — Alternate <br /> p.a (Stc } D r � 1 _ <br /> 3. List food to be sold or given to the public: + ' <br /> 4 1 am providing food that is NOT prepared at home:R(Yes❑No <br /> All food is prepared on-site or is from approved com9Qerdal facilities:IN Yes❑No <br /> Name of facility: c;-r��{ r i r �t Phone. Ca <br /> �a� 3 <br /> Address of facility ez"f <br /> 5 1 am providing a booth with the following.(to protect my unpackaged food and food-preparabon areas horn Hies. <br /> dust and the public) <br /> A booth with walls and ceiling constructed of either wood canvas,plastic,similar material and fine rresn 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 s from approved booths are ed sources those which sell beverages from <br /> approved dispensers.o prepackaged food <br /> g Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods'. <br /> Frgf 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❑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 aperation:.J�Mess❑No <br /> 9. 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 1357: <br /> ❑Camp stove ❑Sterno&hotel trays <br /> ❑Double steamer ❑ Steam table&lids <br /> ❑Electnc stove top ®Other(specify) F+ <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> Hazeltorl A I T 209 488_3420 1 E ?<i TV"r' <br /> page 7 d 1 t <br />