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TEMPORARY FOOD VENDOR’S APPLICATION <br />I.I. Name of Event: <br />2. <br />N-Address: <br />Phono:) <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 cf 11 TFMF FVFNT APPFHD 16 02 <br />08/01/16 <br /> On-site hose bib that is connected to a potable water source. <br />JZ'bther (specify): 5 companmen-f Si^lc______________ <br />Electricity is provided for my booth’s use: hS'os No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved bottled water. <br />I am providing an accurate probe thermomd <br />foods during all times of booth operation: C <br /> Alternate. ( <br />List food to bo sold or given to the public: Atmcrrcanixecl 5001 food <br />The following is information about my organization/business: <br />Name of organization/business: Of <br />ar to measure the hot and cold holding of potentially hazardous <br />Yes No <br /> Camp stove <br />[^Double steamer <br /> Electric stove top <br />I am providing food that is NOT prepared at home: [zf Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes <br />Name of facility:Phone: ( <br />Address of facility: <br />\ -h <br />Note: The only operations not required to provide enclosed booths arc those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Datc(s): YEAR <br />ROUND <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135‘F: <br />No <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. <br />MOUNTAIN HOUSE FARMERS MARKET <br />LCr-f Cty-tAC c-t <br />(Z-OQ )SH -2 56^ <br />EJ A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mosh fly <br />screening, completely enclosing open food areas. Il will also have a smooth and cleanablo floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to sejjarate food and food preparation <br />areas from the public. <br />[Zfother (specify): "buCK- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flics, <br />dust and the public) <br /> Slerno & hotel trays <br />H’Stoam table & lids <br />f^KOther (specify) f r 4AX1 CWiu n tr s