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TEMPORARY FOOD VENDOR’S APPLICATION <br />Date(s) 1. <br />2. <br />Address: <br />Phone: <br />z3.List food to be sold or given to the public <br />4. <br />5. <br />6.Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />Approved bottled water <br />7 Electricity is provided for my booth's <br />8. <br />9 <br />Note:meats, tamales, cooked beans, rice, <br />Page ~ of 11 TEMP EVENT APP <br />•xpfOn-site hose bib that is connected to a potable water source <br /> Other (specify):_________________________ <br /> Camp stove <br />0 Double steamer <br /> Electric stove top <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 />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 />3 <br />EHD 16-02 <br />7/14/15 <br />HA <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 /> Sterno & hotel trays <br /> Steam table & lids <br />ED Other (specify) <br />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 />135T <br /> Other (specify) <br />I am providing food that is NOT prepared at home I^Yes No <br />All food is prepar^d'on-site or is from approved commercial facilities.J^Yes O No <br />Name of facility Phone < <br />Address of facility:_____ <br />use J^fYes O No <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 operatiom/S^Yes No <br />- 6-0'^ <br />IGZ puftS <br />(} '1 <br />Alternate: Alb. <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 />i Name of Event: f*1 A k iJlA <br />The following is information about my organization/business <br />Name of organization/business: <br />^11__Li? .-.yiriL._ULL4— <br />(Gil-: ,'/Sh-