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..,." , 9-%-OWU vr-nluuK'S APPLICATION <br /> All food vendors(boih for profit and non-profit)are required to return a signed and completed copy of this the festival coordinator three(3)weeks prior to this event. checklist to <br /> - 1.{Name of Event_ <br /> Date(s): <br /> Z. The following is information about my organizabonlbusiness: <br /> Name of organizabonlbusiness: !N ` i r- ,L <br /> Address: - <br /> r r_ <br /> Phone: (, ; ) �� oJ - %� _ Alternate_ ( ) <br /> 3• List food to be sold or given to the public: <br /> 4. 1 am providing food that is NOT prepared at home-❑='`es❑ No <br /> All food is prepared on-site or is from approved commercial facilities; Yes❑No <br /> i <br /> Name of facility Phone: <br /> _ Address of facility: D C �3 <br /> c`Z�! <br /> 5- 1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas rum flies,dust and the public) <br /> -- - ❑A booth Mth walls and ceifing constructed of either wood, canvas, plastic, similar materai and fine mesh Ry <br /> screening, completely encinsina open €ood areas_ It will also have a smooth and cleanable floor (concrete, <br /> asphal`, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public_ <br /> ❑Other(specify): <br /> {dote: The only operations not required to provide enclosed booths are those which sell beverages frorn <br /> approved dispensers, or prepackaged foods from approved sources_ <br /> 6. Approved plater far drinking, utensil and hand Leashing will to provided 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 /> a <br /> ' ❑Other(specify): <br /> 7. Electricity is provided for my booth's use: ❑ Yes❑ iNo <br /> 8. l 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 ❑No <br /> 9_ I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br /> 135°F: <br /> ❑ Camp stove ❑ Stemo'. hotel trays <br /> j ElDouble steamer ❑Steam table&lids <br /> j <br /> ❑ Electric stove top ❑ Other(specify) <br /> Note. Examples of potentially hazardous food include: meats, tamales. cooked beans. �i�o <br />