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No. 973:P. i <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />i.I.Name of Event' Date(s; <br />2. <br />Address' <br />3 <br />4 <br />5 <br />[j Omer (specify) <br />6. <br />7 <br />8 <br />9. <br />P»ge ? or 1: <br />TEMP EVENT APP <br /> Camp stove <br />O Double steamer <br />£j Electric stove top <br />asphalt, clean tarps ana smooth wood <br />areas from the public. <br />in my booth by the following methods. <br />EHD 16-02 <br />7/14/1$ <br />the festival coordinator three (3) weeks prior to this <br />u On-Site nose bib that is connected to a potable water source <br />□ Other (specify) LAj <br />0res Q No <br />Q Sterne & notel trays <br />■' Steam table & Ids <br />Q Other • specify) <br />Note: Examples of potentially hazardous food include <br />vegetables, potato salad, eggs, and dairy products <br /> Alternate < ) <br />l am providing food that is NOT prepared at home Pfves 0 No <br />AH food is prepared on-site or is from approved commercial facilities '0/Yes 0 No <br />Name of facility: Phone: , > <br />Address of facility: <br />1 T/CCljrat! probe therTnonW to measure the hot and cold holding of potentrally hazardous <br />foods during all times or booth operation Yes ;| No <br />Electricity is provided for my booth’s use <br />The following is information about my organization/busim <br />Name of organizabon/busmess. <br /> <br />Phene. <br />List food to be sold or given to the public: <br />i am^dmg the following hot temperature control for the hot holding of all potentrally hazardous foods above <br />May. 24. 20 16 11: 25AM <br />£ <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods horn approved sources. ' <br />Approved water for drinking, utensil and hand washing will be provided <br />Approved bottled water. <br />meats, tamales, cooked beans, rice, <br />' Tu^and toe pS)1 fOi,OW'n9: (t° prOteCt my unDacka9ed ah« food-preparation areas from fl.es, <br />booth with walls and ceding constructed of either wood, canvas, plastic similar material and fine mesh flv <br />screening, completely enclosing open food areas It will also have a smooth and cleanabie floor (concrete <br />are acceptable' and constructed to separate food and food preparation <br />All food vendors (both for profit and non-profit) are required tc return a signed gnq completed copy of this checklist to <br />Sv^nt