Laserfiche WebLink
Ali food vendors(both fof -t and non-pn) tl are required tc return a slg W 00—M VWWd coPY of thtS thftltst IC <br /> the festival coordinator in. }weeks pnof to this event <br /> c:v� ; nv �'1`t vk �rt t �cl De is fat-7 - �O�$s 17 <br /> f Name o}f=vent � v fet ) <br /> 2 The f6lawing is Information about rrty organambonlbuismm: . <br /> Name of organizaborilbusirm" �«0 . - s h"Q <br /> Address. G C) t, 1� � , <br /> 0 \ L'%nkV <br /> Phone { ��1- �\+ `� - Altemate.{ ) <br /> 3. List food to be sold or aiven to the public. CZC� CSC!ilj qi�L X l Co-t2L L <br /> 4. 1 am providing food that is NOT prepared at homp,&Yres❑No <br /> All food is prepared ofo-site or is from approved oommencial facHites es L1 No <br /> Name of tWIity hone.L_ <br /> Address of facility <br /> 5 am providing a booth with the following ao protect my unpackaged food and food-preparation areas from flies <br /> AI:A�booth <br /> ousttand the puhlkC with wails and ceiling constructed of either wow. canvas. plastic similar material and fine mesh fly <br /> ng completely enclosing open food areas it wilt also nave a smooth and cleanable floor (concrete. <br /> asphalt. dean tarps and smooth woos are acr_eptatAe; drsd constructed to separate food and food preparation <br /> areas from the oubtic <br /> C_Other �specfy) --- ---- - .. - - <br /> Note. The only operations not required to provide enclosed booths are those whrcii soil beverages from <br /> approved dispensers or prepackaged foods from approved sources <br /> b. Approved water tot dnntang, utensil and hand washing will be provided in my booth t5y the following methods <br /> Approved bottled water <br /> ❑On-site hosts bib that is connecied to a potable water source <br /> Other(specify) <br /> Elecukity is provided for my booth s tt&P, .W' Yes No <br /> S I am providing an accurate probe therrnorrpgtWlto measure the hot and wo holding of potentially hazan]oua <br /> foods during all times of booth operabor, `< yes[ Nn <br /> 9. am providing the following not temperature cor.tr&for the hot holding of ail potentially hazardous foods above <br /> 135°F. <br /> Camp wove Slemo B hotel frays <br /> ❑Double stearref r Steam table&lids <br /> ❑Electric stove top Other(specify) <br /> NoW Examples of potentially hazardous food include: meats, tamalm cooked beans, rice, <br /> vegetables, potato salad.eggs,and dairy products. <br /> EH O ir*w iEmPEvPirAPP <br /> -y. <br /> 1 <br />