Laserfiche WebLink
TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s): 1. Name of Event:1. <br />2. <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify): <br />6. <br /> Other (specify): <br />7. <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT APRPage 7 of 11 <br />s <br />EHD 16-02 <br />7/14/15 <br />I am providing an accurate probe thermometer, <br />foods during all times of booth operation: <br /> Camp stove <br />[/^Double steamer <br /> Electric stove top <br /> Stemo & hotel trays <br />[ZfSteam table & lids <br /> Other (specify) <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 />Electricity is provided for my booth's use jZfYes Q No <br />cajun <br />The following is information about my organizjation/business: <br />TOOa <br />fA BASU’S <br />LA* qTsbS <br />Con <br />■Jo measure the hot and cold holding of potentially hazardous <br />Yes No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />[/^Approved bottled water. <br />[Zfon-site hose bib that is connected to a potable water source. <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 />Name of organization/business: M 611 Pt (c C^~ <br />(C]7S ) 2-3^ ~ Alternate^ ) <br />List food to be sold or given to the public: 0 | l^rT/dp j CGcOnU'T (j <br />I am providing food that is NOT prepared at home: [^Yes <br />All food is prepared on-site or is from approved commercial facilities: <br />Name of facility: £ G LUa A <br />Address of facility: ^5 2- Gz I ( t. M <br />EfYesDNo PVPU^ <br />_________Phone: £ <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 />pCX 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 />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 />Cfliiin RIUtT WN4I