Laserfiche WebLink
PS2016 12:27PMJun. <br />FROM :FRANK <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Ail food vendors (both for profit and non-profit) are reared to return a S.gned and completed copy of this checklist to <br />Datefs): 1. Name of Event:1. <br />2. <br />Address. <br />Phone: <br />List food to be sold or given to the public:3. <br />4. <br />5. <br /> Other (specify) <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods.6 <br />•roved bottled water <br />O On-srte hose bib that is connected to a potable water source <br />7. <br />8. <br />9. <br />Page 7 of 11 <br />5 <br />EHD 16-02 <br />7/14/15 <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 /> Other (specify) _____________ . <br />Electricity is provided for my booth's use &Yes O No <br />Q Camp stove <br /> Double steamer <br /> Electric stove top <br /> Sterno & hotel trays <br /> Steam table & lids <br />[pother (specify) - <br />I am providing a booth with the following: (to protect my unpackaged food and food-preparatton areas from flies, <br />dust and the public) <br />meats, tamalee, cooked beans, rice, <br />■Ht'dvp.L. <br />TEMP EVENT APP <br />the festival coordinator three (3) weeks prior to this event. <br />zni6 0 fev-PES Yasvt.o^v, <br />The following is information about my organization/busmess. <br />Name 0< organmmlo^s.ne.e hW-A-TC&SA \XCh-XS <br />------------ <br />f-A7a42. -7 Alternate (?/£ 1 - l<2gg <br />/vfeza-r Fcsvwco __ <br />[ZM 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 />above <br />n0,6^4 <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: ETYes Q No <br />I am providing the following hot temperature control tor the hot holding of al! potentially hazardous foods <br />135°F: <br />I am providing food that is NOT prepared at home: K Yes O No <br />All food is prepared on-site or is from approved commercial facilities: [3 Yes O No <br />Name of facility: A-TCsISkC MexTf . Phone: I 1_________ <br />Address of facility: ST <br />NO. :19166866756 <br />’zj?/'i, ^-1 £A i 12r/^_ <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products.