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6 <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />Datefs): J- <br />2. <br />Name of organization/business: <br />Address: <br />Phone: <br />3. <br />4. <br />5. <br />6. <br />7. <br />135T: <br />meats, tamales, cooked beans, rice, <br />TEMP EVENT AFPPageTofllEHD 16-02 <br />11/4/14 <br />9. <br />AB 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 .TO d -------- <br />The following is information about my organization/business; <br />■ ■ - ■ : <br />ISH _____ <br /> Alternate: <br />List food to be sold or given to the public: <br /> Camp stove Stemo & hotel trays <br /> Double steamer Steam table & lids <br /> Electric stove top Other (specify) P <br />Note: Examples of potentially hazardous food include: <br />vegetables, potato salad, eggs, and dairy products. <br />I am providing food that is NOT prepared at home: O Yesr^f No <br />AH food is prepared on-site or is from approved commercial facilities: QVes Q No <br />Name of facility:Phone: [—_J------------------------------ <br />Address of facility:.___________ _———— --------------------------------- <br />I am providing a booth with the following: (to protect my unpackaged food and food-pn^jaration areas from flies, <br />dust and the public)• <br />Q'A booth with walls and ceiling constructed of either wood, canvas, plastic, simitar material and fine mesh fly <br />screening, completely endosing open food areas. It will also have a smooth and cteanabte floor (concrete, <br />asphalt dean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br />areas from the public. <br />Other (specify): M'Fp <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 wilt be provided in my booth by the following methods: <br /> Approved bottled water. <br />0T>n-site hose bib that is connected to a,potable water source. <br />O Other (specify): <br />Electricity is provided for my booth’s useJ^Yes No <br />8. 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^JEJVes No <br />I am providing the fallowing hot temperature control for the hot holding of all potentially hazardous foods above