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c <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />1. <br />2 <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br /> Other (specify) <br />6. <br />7. <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: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />©’Approved bottled water. <br /> Sterno & note! trays <br />nTsteam table & lids <br /> Other (specify) <br />Electricity is provided for my booth’s use: M^Yes Nc <br />EHD 16-02 <br />7/14/15 <br />O On-site hose bib that is connected to a potable water source. <br /> Other (specify): . <br />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135“F: <br />Note: The only operations not required to provide enclosed booths ere those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br /> Date(s): CVuh <g <br />'Hr^CizAdAt 6-A ^/Q. I <br />______Alternate: (M f <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: <br />Name of facility: <br />Address of facility: if .T/fy-7 4k. T'vi.r.T <br />; LEjYes No <br /> Phone: (^f (S ) , aT ? <br />151 C F".; /.I1 49/7-^/ <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 />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 />l am providing an accurate probe thenmometerto measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: ©Yes No <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 />1, Name of Event: CAjfypn f ?. ( a--'C <br />The following is information about my organization/business: <br />HaName of organization/business: <br />(M/m nfc-Wv-V ~ <br />List food to be sold or given to the public: fe pi L-