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TEMPORARY FOOD VENDOR’S APPLICATION <br />non-profit) are required to return a signed and completed copy of this checklist to <br />Date(s):1. Name of Event: 1. <br />2. <br />Address: <br />Alternate: () Phone: <br />List food to be sold or given to the public:3 <br />4. <br />5. <br /> 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 />L~] On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />Electricity is provided for my booth's use: Q Yes Ci No7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 of 11 TEMP EVENT APP <br /> Camp stove <br /> Double steamer <br /> Electric stove top <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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />EHD 15-02 <br />11/4/14 <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: Q Yes O No <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 />Name of organization/business:___( <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 />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />All food vendors (both for profit ani <br />the festival coordinator three (3) vvifeks prior to this event. <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135T: <br />JU J _____ <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:Phone f 1 <br />Address of facility: _______________ <br />The following is information about my ornanization/busines^ <br />....... : /fyio/L <br />8 i h,