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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. <br />2. <br />3. <br />4. <br />Del i <br />5. <br /> Other (specify): <br />6. <br /> On-site hose bib that is connected to a potable water source. <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />08/01/16 <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />ETApproved bottled water. <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br /> Other (specify):____________________ <br />Electricity is provided for my booth’s use: 0Yes No <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Efsterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />p-o. <br />Address: <br />Address of facility: | K 7 6 C f\~~ /-/ , <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br />ETA 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, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />I am providing an accurate probe thermometej; to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Qres No <br />(2<^7 ) VV3 - . <br />3 cl I If AO <br />|4e> f Jr <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. Name of Event: <br />H-i'tc R v +S -The following is information about my organization/busmess: <br />Name of organization/business: Imden hand feco^-g/.s <br />Hod- CA- ^5236^ <br />Phone: (^>7) 5^-7/542 ___ Alternate: <br />KoA-net Dtwid ~ , <br />List food to be sold or given to the public:ftrcLLkA,'LL/T D u.tiO j HQp k . <br />CkvpSy Cookies <br />I am providing food that is NOT prepared at home:^) Yes No ' <br />All food is prepared on-site or is from approved commercial facilities: Yes No <br />Name of facility: C-f -E)(R I_________________Phone: £/