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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 000rdinator three(3)weeks prior to this event. <br /> 1. 1.Name of Event {'L) �1�p(� 4 it _Date(s): f 7 r 1 <br /> 2. The following is information about m�yf�organtra ontbusiness: <br /> Name of organization/business: <br /> Address: .� lJ d}, <br /> Phone: ( r�) S� -�76 7 A ternate: (a6 1 ) (A Y , - 7 <br /> 3 List food to be sold or given to the public; �<-e Me-t Q _ <br /> 4. 1 am providing food that is,1M,QT prepared at home: [5 Yes❑ No <br /> All food is prepared on-site or is from approved commercial facilities: ®Yes❑ 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 /> YqA booth with walls and ceiling constricted 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, 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 /> 6. Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br /> (ElApproved bottled water. <br /> ❑ On-site hose bib that is connected to a potable water source. <br /> Other(specify): <br /> 5 6--�c k-P-S r� <br /> 7. Electricity is provided for my booth's use: ❑Yes QZNo <br /> 8. l am providing an accurate probe thermometer to njeasure tt� hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: ❑Yes Nl/No / / <br /> 9. 1 am providing the fallowing hot temperature oontrol for the hot holding of all potentially hazardous foods agave <br /> 135"F. <br /> ❑ Camp stove ❑ Stemo&hotel trays <br /> ❑ Double steamer ❑ Steam table&lids r <br /> ❑ Ekx;t is stove top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, twnales, cooked boars, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />