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L <br /> TEMPORARY FOOD VENDOR'S APPUCATION <br /> .Ail food vefAcrs(both for profd and non-profit)are required to return a signed anf co mpleted coley of this checklist to <br /> the festival coordinator three(3)weeks Poor to this event <br /> 1 1 Name of <br /> 2 T1te following is intormatton about my orgarization.+bumness r n <br /> v i <br /> Name of ofganizatkuVbutwnesv —co <br /> f C— _-- - <br /> Address. <br /> Phoney j 1"J d� _�� wternate:( ) <br /> 3 fist foci Io be sold or groan to the public. <br /> S <br /> V, Gy � <br /> o } Ue� r �✓1 � ' Gq�c�Se ea <br /> q- 1 am providing food that is NOT p epared of ome es L. N t �-l <br /> All food is prepared on-site or is from approved commercialfacilities Yes[� No 0",O <br /> Name of facilrty O L Phone.VL <br /> ((�f— <br /> Address of fAality _ <br /> 5 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 /> LA booth with walls and ceiling constructed of either wood canvas. plastic similar material and fine mash fly <br /> screening, completely enclosing open food areas It will also have a smooth and cleanable ffaor (concrete. <br /> asphalt dean tarps and smooth wood are aoceptable) and constructed to separate food and food preparation <br /> areas from the public <br /> [_ Othef(specify) . -- -- - - ---- <br /> Note. The only operatians not [equired to provide enclosed booths are those which sett beverages from <br /> approved dispensers or prepackaged foods from approved sources. <br /> o Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods <br /> approved bottled water <br /> ,�16n-site hose bib that is connected to a potable water source <br /> Other(specify) <br /> 7 Elecbtaty is provided for my booth s use - es L;No <br /> 8 I am providing an accurate probe therrnomete to measure the hot and card ttolding of potentially hazardous <br /> foods during all times of booth operation es n No <br /> 9 1 am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F <br /> [;Camp stove Stwmo& hotel trays <br /> G Double steamer 7 Steam table&lids <br /> Eiectnc stove top L,: Other(specify) <br /> Note. Examples of potbribAHy Hazardous Woo Include- meats, tsmalss, cooked basins. nee, <br /> vegotabkes, potato salad.eggs,and dairy products. <br /> TrMP F'v FN7 4n% <br /> FND <br /> ZC ,� <br /> L. <br />