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1. <br />2. <br />C 4 u p <br />5 3>C>Ort zAddress: <br />3. <br />4. <br />5. <br />6. <br />0 Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />9. <br />7. <br />8. <br />I.Name of Event: <br />The following is information about my organization/business: <br />L.Q-Of utTfuG. <br />__ Alternate: ( V -------------- <br />frALHoS/ OR-/cvj <br />All food vendors (both for profit and non-profit) are <br /> Other (specify):__ <br />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 />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Phone: (‘■tO^) <br />List food to be sold or given to the public: HoT z <br />------COUNTY------ <br />Greatness grows here. <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. <br />Pl o P t, i <br />I am providing food that is NOT prepared at home: 0 Yes No <br />All food is prepared on-site or is from approved commercial facilities: 0 Yes 0 No <br />Name of facility: pAftk 3>MAck OAfl-------Phone: (-------)-------------------------------------- <br />Address of facility: ?OQ <0^^^ D<t , lATM^O^7 ----- ----- <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />O'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, dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />0 Other (specify): ' I kJ 4|fvk,5 <br />Electricity Is provided for my booth’s use: Q Yes O No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes 0 No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />0 Camp stove <br />0 Double steamer <br />0 Electric stove top <br />Name of organization/business: <br />I7I52- \ZftiAJ kofrU <br />h 9 - 9- G C> <br />Date(s): 05/02/2.- O7z3J/iQ <br />[ZTStemo & hotel trays <br />0Steam table & lids <br />0Other (specify) GdOCK. Fof S <br />Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice,