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TEMPORARY FOOD VENDOR’S APPLICATION <br />1. Name of Event: 2qi b1. <br />2. <br />Name of organization/business <br />Address: <br />Phone:Alternate: () <br />3. <br />4. <br />5. <br /> Other (specif'/) <br />those which sell beverages from <br />6. <br />7.Electricity is provided for my booth’s <br />8. <br />9. <br />meats, tamales, cooked beans, rice, <br />Page 7 erf 11 TEMP EVENT APP <br /> On-site hose bib that is connected to a potable water source <br />O Other (specify): <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />0 Camp stove <br />0T)ouble steamer <br /> Electric stove top <br />Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />use: 0 Yes No <br />are required to return a signed and completed copy of this checklist to <br />EHD 16-02 <br />7/14/15 <br />Note: The only operations not required to provide enclosed booths are <br />approved dispensers, or prepackaged foods from approved sources <br />No <br />___1 <br />I am providing food that is NOT prepared at home: Q^es No <br />All food is prepared on-site or is from approved commercial facilities: 0Yes 0 <br />Name of facility: '^a/4 C Phone: £_ <br />Address of facility: / Y c y. <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 />0-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 />I am providing the following hot temperature control for the hot holding of all potentially hazardous foods above <br />135°F: <br />Date(s): <br />All food vendors (both for profit and non-profit) <br />the festival coordinator three (3) weeks prior to this event. <br />-A jop Qi <br />The following is information about my organization/business <br />T J S/iCtClc 3 (J/yy <br />ioob /- Gi-T /YY p 0-, 5 0 <br />(TcT ) '70 - d/ _________ <br />List food to be sold or given to the public: 0:^6/Liz- ,yp <br />I am providing an accurate probe thermometer to measure the hot and cold holding of potentially hazardous <br />foods during all times of booth operation: 0 Yes 0 No <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Q^pproved bottled water.