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TEMPORARY FOOD VENDOR’S APPLICATION <br />completed copy of this checklist to <br />the festival coordinator three (3) & <br />Date(s): 1. Name of Event: 1. <br />2 <br />Address: <br />Phone: <br />3 <br />4. <br />5. <br />LS-^ner (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 /> On-site hose bib that is connected to a potable water source. <br />Q Other (specify): <br />Jres NoElectricity is provided for my booth's use'7 <br />3 <br />9 <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APPPage 7 of 11=H0 15-02 <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 />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 /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />O Camp stove <br /> Double steamer <br />r^fSlectric stove top <br />Q 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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135’F. <br />All food vendors (both for profit and nonprofit) are required to retiirri_a_sj©ped an: <br />!k<prior to |hte event. / I___ _ / <br />The following is information about my organization,'business: I / / <br />I '4/WA'S KlK <br />I am providing an accurate probe thermomet§i>to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: o Yes Qj No <br />I am providing food that is NOT prepared at home: B'Yes No <br />All food is prepared on-site or is from approved commercial facilities: i^^es No <br />Name of facility:Phone £1 <br />Address of facility:__ ___ __________________ <br />Name of organization/business: [ ✓ A r I . ( CJ4/V77 <br /> <71 ?)-toMr7 Alternate: ( /-j) zj________________ <br />List food to be sold or given to the cubliS^V" [ (' (\ P