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1. <br />2. <br />Address: <br />3. <br />5 <br />6 <br />8 <br />o <br />rice. <br />7=mp eve:: <br />Page 7 of 11 <br />EHD 16-02 <br />7/23/10 <br />asphalt, clean tarps and smooth wood <br />areas from the public. <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />Note: Examples of potentially <br />V( <br />^Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />/ hazardous food include: <br />egetables, potato salad, eggs, and dairy products. <br /> Other (specify): <br />Electricity is provided for my booth s <br />I am providing an accurate probe thermomete <br />foods during all times of booth operationWJ <br />I am providing the following hot temperature control for the <br />135°F <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />a signed and completed copy of this checklist to <br /> I Date(s): <br />Name of organization/business: — <br /> |llp^l a <br />Phone <br /> <br />List food to be sold or given to the public„ <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 <br />Phone: ( )----------------------------- <br />Name of facility:----------- ---------------- ----------------------------- <br />Address of facility:------------------------------- ------------------------------------------------------------------------ <br />, am providing a booth w,th the following; (to protect my unpackaged food and food-preparat.on areas from flies, <br />dust and the public) <br />booth with walls and ceiling “nstr^,e^^of eith®r "“ajs^have a smooth"S Stable floor (concrete <br />"Y; wood are^acceptable) and constructed to separate food and food preparation <br /> Other (specify):------------------------------------------------------------------------------- <br />Note- The only operations not required to prov.de enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved source . <br />Approved water for drinking, utensil and hand washing will be prov.ded in my booth by the following methods: <br />^Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />use: ^Yes □ No <br />--■ter to measure the hot and cold holding of potentially hazardous <br />Yes No <br />hot holding of all potentially hazardous foods above <br />All food vendors (both for profit and non-profit) are required to return <br />the festival coordinator three (3) weeks prior to this eve . <br />1. Name of Event. <br />The following is information about my organization/business: <br />fynnffCM i otlopl CluL)______ <br />Ob Qifl1-/ f/j ^ZLp._____ <br />■ Alternate ( <br />meats, tamales, cooked beans,