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TEMPORARY FOOD VENDOR'S APPLICATION <br /> AI! 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 th`rree(3)weeks prior to this event <br /> 1. 1.Name of Event: f\ n�(o 1.19b (� NAMILN lb JAJY Date(s): <br /> Z. The following is information about my organization/business: <br /> Name of organ izationlbuslness: <br /> Address: HO WMA, i Q-CI11 LA G zlp - <br /> Phone: ( 2UM ) 151 30 LIP TAkernate:( 2Oil <br /> 3. List food to be sold or given to the public: yv�x <br /> 4. 1 am providing food that is NOT prepared at home: Yes❑ No <br /> All food is prepared on-site or is from approved commerciat facilities: Yes❑No <br /> Name of facility: 1 k - n _TF[fione: <br /> Address of facility:1 1- a 1itu W01V 1 na-1 c L a. C l 615 3?, tv <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 /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> sc eening, 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 enctosed 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 /> L�'Approved bottled 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:.9Yes❑ No <br /> 8. 1 am providing an accurate probe thermornipte'r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operation: Yes❑No <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 ❑5temo&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 /> COMPLETE BOTH SIDES AND RETURN WITH EXHIBITOR AGREEMENT <br />