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Sth--1t-tuio uD;Dc r r cim. t V•LJJLJJu1...•1 ��c•.- . <br /> yx S <br /> TEMPORARY FOOD VENDOR'S APPUCA'110N <br /> All foot!vendors(both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival wardinator three(3)weeks prior to this event. ti <br /> 1. 1.Name of Event:ftrmatcon <br /> Date(s):2- The fallowing is in my o n'u:zd <br /> r <br /> Name of organlzation/buslness 1 <br /> Address: <br /> Phone: x Alternate:( ) I <br /> 3. Listfood to be sold or green to the pubtic: <br /> 4. 1 am providing food that is NOT prepared at home Yes No <br /> All food is prepared on-site gar is,from approved,commercial facilities: Yes Q,No <br /> Name of facility. Phone:,� } <br /> Address of facility: <br /> 6- I am providing a tooth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br /> dust and the public) h <br /> }�i A booth with wails 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, f <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the. public <br /> I <br /> ❑Other(specify): ; <br /> f <br /> Note: The only operations not required to provide. encbsed booths are those which sell beverages from � <br /> approved dispensers,or prepackaged foods from approved sources. <br /> r <br /> 6. Approved water for Oinking.utensil and hand washing will be provided in my booth by the following methods: <br /> ❑Approved bottled water. <br /> XOn-sits hose-bib-that is connected to a potablib'Watcr Source: <br /> 0 Other(specify): i <br /> 7. Electricity,is provided for my booth's use: © Yes/No s <br /> 6. 1 am providing an accurate probe thermomeV 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 /> Camp stove /Stemo &hotel trays j <br /> i <br /> ❑Double slearner 0 Steam table&lids � <br /> ❑ Electric stove top El Other(specify) <br /> Not,a: Examples of potentially hazardous food Include: meats, tamales, cooked beans, rice, <br /> vegetables, potato salad,eggs,and dairy products. <br /> ENo IB-02 page 9 of 11 TEMP EVEN7APl? <br /> 7128li� , <br /> i <br /> l <br /> i <br />