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TEMPORARY FOOD VENDOR'S APPLICATION <br /> A!1 food vendors(both for profit and non-proM) are required to return a signed and completed cagy of this checklist to <br /> the festival coordinator threen(3)weeks prior to this event. <br /> 1. 1.Name of Event: /y`!Q T e k 1r-*' , <br /> 2. The following is infomiation about my organ izaborvbusiness: <br /> Name of organizatiordbusiness: lac. 1 S Ke44 ire ec r <br /> Address: Kam[ <br /> Phone: (20 ) Alternate: (7* ) S 24-9y /�7 <br /> 3. List food to be sold or given to the public: sv h M I k S d <br /> 4. 1 am providing food that is NOT prepared at home: ❑ Yes xNo w4 ctS <br /> All food is preparedlE3 is from approved commercial facilities:)dyes❑ No <br /> Name of facility: Phone: <br /> Address of facility; <br /> 5. 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) <br /> kbrth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> , completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <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 /> fit Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> Approved battled water. <br /> ❑On-site hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes�-g(No <br /> 8. 1 am providing an accurate probe thermometer tom sure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑ YesNo /V/� <br /> r �r <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 ❑ Stemo &hotel trays <br /> ❑ Double steamer ❑ Steam table&lids <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> EHO 16-02 Pa@e 7 Of 11 TEMP EVENT APP <br /> 712W 10 <br /> /1 <br /> 'J <br />