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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event: 9 C. fT )At— A1. <br />2. <br />ec' <br />Bl 9920^Address: <br />) Alternate: (Phone: <br />3. <br />4. <br />5. <br />pre - Other (specify): <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods:6. <br /> Approved bottled water. <br /> Other (specify): <br />Electricity is provided for my booth’s use:7. <br />8. <br />9. <br />TEMP EVENT APPPage 7 of 11EHD 16-02 <br />11/4/14 <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 /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Name of organization/business: _ <br />( > <br />List food to be sold or given to the public: <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 />53 C VCi VW ■\z>. (A q <br /> A 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 />The following is information about my organization/business: <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 /> Date(s): rvxjivxj. <br />( C.J1-kk u \ <br />r meat^, 'lamales, cooked beans, rice, <br /> Sterno & hotel trays j <br /> Steam table & lids <br />^Other (specify) ^Id <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <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:JZl Yes No <br />Name of facility: Si 11 u c r GMr- fe,Phone: (9/^>) <br />Address of facility: HbioT Frnkiklin ) Cey_________________ <br /> On-site hose bib that is connected to a potable water source. <br />A1 I ____ <br /> Yes No <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: Yes [J No <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />A 36 — <br />^\ce n)crd le. S'