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TEMPORARY FOOD VENDOR'S APPLICATION <br /> and QVHN06t)are required tc ratum a sided and cornpieteci copy of toes chedtlost to <br /> All food vendors (both far l� <br /> the fesbval coordinator three(3)weeks prior to this event. <br /> i� �i4a Date(s) t'l� `% <br /> i Name of Event __ANTfI� �"^- <br /> 2 The following rs inforrhabOn about my,� ws <br /> riess organization/busine <br /> /V�Il!# .?+Eft iZS__.j! <br /> Name of organvafirxi/busi — — <br /> Address. 600 <br /> o �- 3 <br /> Phone { $tC� )�0�._�9��-�_—_—_--_.. Aitemate. i.�/ r — <br /> 3 List food to be sold or giveii to the public. /h1/7/ ---- <br /> 4 I am providing food that is NOT prepared at home D? yes L No <br /> All food is prepared on-site or is from approved commercial facilities IX Yes❑No <br /> Name of facility -_-- tml St� -- Phone: — <br /> Address of facility. __ <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 /> A booth with wails and reefing construided of either wood, canvas, plastic. similar material and fine mash fly <br /> screening. completely enciosing open food areas It will also wave a smooth and cleanable floor ncree. <br /> asphalt, dean tarps and smooth wood are acceptable! and constructed to separate food and food preparation <br /> areas from the public <br /> ether (specify). —�_. ___�--------- ------- - <br /> Note: The onty operations riot required to provide enclosed booths are those whrclt sell beverages from <br /> approved dispensers.or prepackaged foods from approved sources, <br /> 5 Approved water for drinking. utensil and hand washing will be provided in my booth by the following methods <br /> Approved hotbed water <br /> tY 7 On-site hone bib that is connected to a potame water source <br /> Outer(specafy) -- -- ---- <br /> Electricity is provided for my booth's use tR Yes E No <br /> g 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 5kYes n Nn <br /> S I.am providing the following hot temperature control for the hot nolding of all polenttalty hazardous foods above <br /> i35"P' <br /> L_3 clamp stove 1- Stern& hotel trays <br /> ❑ Double steamer i 1 Steam table& lids <br /> `! Electric stove top Qthet(spec:rfy) <br /> Mote: Examples of p4tentisily hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> rEIVIP EVENT APP <br /> E.iL tin: <br />