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TEMPORARY FOOD VENDOR'S APPLICATION <br /> All food vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator three(3)weeks prior to this event <br /> 1. 1 Name of Event LUAl PK I✓1 VVI iC Date(s): G� f <br /> 2. The following is information about my organizationlbusiness: <br /> Name of organization/business. <br /> - � <br /> Address: ra <br /> Phone: ( '� ► S Alternate:(Q2s) ,62-O <br /> 3 List food to be sold or given to the public:�Gbr'14 $T COAJ. Y9 4-_"46e <br /> 4. 1 am providing food that is NOT prepared at home: U'� es❑ No <br /> All food is prepared on-site or is from approved commercial facilities: Yes❑ No <br /> Name of facility h j y Phone: Z4�'.O <br /> Addresss of facility c�G 1� O a 4 <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 /> 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 /> ❑Other(specify): <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers,or prepackaged floods from approved sources. <br /> S. Approved water for drinking,utensil and hand washing will be provided in my booth by the following methods: <br /> W/Approved bottled water. <br /> "-sft hose bib that is connected to a potable water source. <br /> ❑ Other(specify): <br /> 7. Eledncity is provided for my booth's user Yes❑ No <br /> 8. l am providing an accurate probe thermornet to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: SYes ❑No <br /> 9. 1 am providing the fnliorwing 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(spay) <br /> Note: Examples of potentiality hazardous food include: meats, tamales, cooked beams, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />