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@00106/09/2016 17:35 FAX 8317245784 <br />I <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />I.Name of Event: 1. <br />2. <br /> <br />Address: <br />Phone: <br />3. <br />4. <br />1 <br />5. <br />6. <br /> Approved bottled water. <br />On-site hose bib that is connected to a potable water source. <br /> Other (specify): <br />7. <br />8. <br />meats, tamales, cooked beans, rice, <br />TFMP FVCNT APP <br /> <br />P*a* 7 nf 11EHD 16.02 <br /> Camp stove <br /> Double steamer <br /> Electric stove top <br />I am providing an accurate probe thermomi <br />foods during all times of booth operation J? <br />3 Yes No <br />Phone: (___ <br /> Other (specify):................... .. ............... —-----------—------ ------------- <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 />Approved water for drinking, utensil and hand washing will be provided In my booth by the following methods: <br /> Sterno & hotel trays <br /> Steam table & lids <br /> Other (specify) <br />Electricity is provided for my booth’s use’JZTves O No <br />Sr to measure the hot and cold holding of potentially hazardous <br />Yes No <br />Note: 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 />135°F: <br />the festival coordinator three (3) weeks prior to this event. <br />Ca4 J W r <br />The following Is Information about my organlzation/buslness: <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />j Pate(s):<J^t<^^^~Z£ <br />, Alternate: <br />Snmk] . <r>' x_____ <br />__________i~ Alternate: (< <br /> <br />List food to be sold or given to the public: <br />I am providing food that Is NOT prepared at home^ZfYes No <br />All food is prepared on-site or Is from approved commercial facilities: <br />Name of facility: . ....-----—-----—— <br />Address of facility: /. -—------ <br />\ am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dustpnd the public) <br />0A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />/&reening, 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.